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Small Business Employee Benefits and HR Blog

How to Apply for Individual Health Insurance in 2015

How do people apply for individual health insurance in 2015? What questions will be asked, and how will the process work? Does it work the same as last year? These are common questions with open enrollment 2015 coming up in November.
apply individual health insurance 2014

Our biggest tip to any employer or employee is: work with a health insurance agent to help employees navigate insurance plan options, the health insurance Marketplaces, and the premium tax credits.

Here's an overview for employees on how individual health insurance works, what to expect when applying for individual health insurance, and how to apply for individual health insurance in 2015.

How Individual Health Insurance Works

  • Any individual or employee can purchase an individual health insurance plan.

  • You select the insurance company, the plan, and the options that best fit you and your family (such as what is covered, network of doctors, deductibles, co-insurance, etc).

  • You can purchase the plan from a health insurance agent or broker (recommended), through the health insurance marketplaces, online through a private insurance website, or directly from the insurance company. The health insurance marketplaces will open for shopping and enrollment October 1, 2013, with plan coverage starting January 1, 2014.

  • Once purchased, the plan is yours. Unlike most employer plans, you can switch plans, coverage options, or even health insurance companies any time you want. 

  • The plan is portable. If you leave your employer you can keep the plan.

Individual Health Insurance in 2015

Individual health insurance has undergone four significant changes because of health care reform (the Affordable Care Act).

  1. Guaranteed-Issue: Medical underwriting has gone away, and all plans are "guaranteed-issue". This means that all individuals are accepted regardless of health status, and will not pay more because of health status. The only up-rating (charging more) allowed is for tobacco use, age, and location. Additionally, health reform has put limits on the amount an insurance company can up-rate for these factors. 

  2. Federal Premium Tax Credits: Premium tax credits are available to eligible individuals for plans purchased through the individual health insurance marketplaces. Households with income between 100% and 400% of FPL who purchase coverage through a state (individual) health insurance Marketplace are eligible for a premium tax credit to reduce the cost of coverage. To be eligible, employees cannot be offered affordable, qualified health insurance through their employer.

  3. Essential Health Benefits: Starting in 2014, all plans are required to include essential health benefits, a core package of items and services. 

  4. Open Enrollment Periods: There are set open enrollment periods when employees can enroll in guaranteed-issue health insurance. This year's open enrollment period is November 15, 2014 to February 15, 2014. The Marketplace open enrollment periods ensure that individuals and families don’t wait until they get sick to enroll in coverage, or switch to more comprehensive coverage when they are about to have an expensive medical procedure.

What to Expect When You Apply

Filling out a health insurance application post-ACA is much easier. There are no medical history questions, aside from tobacco use. If you are eligible for federal premium tax credits or Medicaid, you will see financial questions to screen you for these programs. Here are the five steps to expect when you apply through the health insurance Marketplaces:healtcare.gov

  • Step 1: Go to your state's Individual Health Insurance Marketplace website (e.g. www.healthcare.gov).

  • Step 2: Complete online or paper application. See sample health insurance marketplace applications here.

  • Step 3: The website will display all available plan options within metallic tiers. Displayed cost will factor in premium tax subsidies.

  • Step 4: Select plan.

  • Step 5: Marketplace bills you for your portion of premium (i.e. the total premium minus premium tax subsidy) and forwards your payment to the carrier.

What You’ll Need When You Apply

Here's the basic information you’ll need when filling out the application for individual health insurance in 2015. Be prepared with the following information:application marketplaces

  • Date of birth

  • Social security number & citizenship status

  • Tax filing status, and number of dependents*

  • Current job and income information including current employer, wages, hours worked (tip: have a current paystub available)*

  • Other income information such as pensions, rental income, alimony received, unemployment income, etc.*

  • Current insurance information such as how you are insured (employer, Medicaid, individual health insurance, etc)*

  • Payment information, such as a credit card or bank draft (ACH) information

*These questions will only be asked if you are applying for federal assistance (premium tax credits, cost-sharing, Medicaid, CHIP, etc).

Individuals who currently have an individual health insurance policy should check with the insurer about when the policy ends to review their renewal options. Some policies purchased through the Marketplace will allow auto-enrollment for current Marketplace consumers, meaning the policy will auto-renew if no action is taken.

Will applying for individual health insurance in 2015 be easier than last year? Join the discussion in the comments below.