An increasing number of employers are adopting reimbursement models like health reimbursement arrangements (HRAs) for their employees' health benefits to save on healthcare costs and to provide a more tailored solution for their employees’ needs. HRAs empower employees to choose their own individual health plans and enable their employers to reimburse them, tax-free, for their premiums.
The freedom to choose your own policy is great for your healthcare, but it can be daunting to shop for your own insurance plan if you've never done it before. While there are several ways to shop for individual health insurance, the most common way is through the federal Health Insurance Marketplace or state exchanges.
In this article, we'll walk you through the five-step process of shopping and applying for Marketplace coverage so you can choose the right plan for you and your family.
See what you can expect to pay for health insurance in your state with our chart
What is individual health insurance?
Individual health insurance is a health plan individuals purchase for themselves from a public or private exchange. It can refer to self-only coverage that an individual purchases for themselves, or family coverage purchased by an individual for their entire household. Either way, it is not job-based and not offered by employers. These individual plans work differently than traditional group health plans, which an individual's employer selects and sponsors.
Individuals can purchase these policies through a health insurance agent or broker, so they get help understanding and navigating insurers, coverage options, and premium costs.
However, since the Affordable Care Act (ACA) went into effect, many Americans shop for their own individual health insurance with the help of online Health Insurance Marketplaces, which include the federal Marketplace and state-based exchanges.
With the creation of ACA, insurers can no longer deny health insurance to individuals with preexisting medical conditions. Those shopping for individual coverage may also have access to federal premium tax credits that are available to those who qualify based on their income. This subsidy helps Americans with their monthly premium costs.
Additionally, all Marketplace health plans are qualified, meaning they cover the ten essential health benefits.
When you can apply for individual health insurance?
Usually, you can only sign up for a health plan during the open enrollment period at the end of the year. This generally runs from November 1 through January 15. States with their own exchanges can have shorter or longer open enrollment periods.
However, special enrollment opportunities exist if you experience certain qualifying life events. If your current employer just offered you a reimbursement plan, like an HRA, then you may qualify for a special enrollment period that allows you to shop for a plan outside the regular enrollment period. Other life events like turning 26 or losing coverage can also allow you to change your coverage during a special enrollment period.
Where can you purchase an individual health insurance plan?
You can purchase your individual or family policy from a public or private exchange. Private exchanges are online resources typically set up by a health insurance company, a licensed broker, or an insurance agent. Public exchanges include the federal and state marketplaces. In the steps below, we’ll cover how to apply for individual health insurance on the public exchanges.
Step 1: Go to HealthCare.gov or your state's exchange
The ACA created the online Health Insurance Marketplaces, both the federal Marketplace and state-based exchanges, to help Americans sign up for their own individual and family health insurance coverage.
To compare health plan choices, you'll need to see if your state has its own health insurance exchange. You can check on our state-by-state guide. If your state doesn’t have its own exchange, you'll use the federal exchange at HealthCare.gov1.
Step 2: Complete the online Marketplace application
Whether you visit the federal or state public exchange, you’ll need to create an account to get started.
Whether you're applying for a policy for the first time or renewing your current health insurance plan, the Marketplace website will walk you through several questions via online forms to help determine your age, financial status, and location.
You can expect to provide the following information during the application process:
- Date of birth
- Social Security number
- Contact information, such as your mailing address, ZIP code, email address, and mobile phone number
- Tax filing status*
- Number of dependents*
- Current job and household income information*
- You must also provide the Social Security number of anyone helping you pay for the policy to determine household income eligibility, even if they aren't directly applying for the health coverage.
- Other income information such as pensions, rental income, received alimony, unemployment benefits, disability benefits, etc.*
- Current insurance information, if applicable, such as how you are insured (employer coverage, Medicaid, individual health insurance, etc.)*
- Payment information, such as a credit card or bank draft (ACH) information
*These questions are only asked if you apply for federal financial assistance (i.e., premium tax credits, cost-sharing, Medicaid, CHIP coverage, etc.).
Aside from your tobacco use, there won't be any questions about your medical history. As stated above, the ACA mandated that no one should pay more for insurance because of their health, so there's no need to worry about having any medical records on hand.
Overall, completing the form should take between 15–30 minutes. After that, you'll receive email updates regarding your application status.
You can also enroll in coverage over the phone or by mailing in a paper application2.
Step 3: Choose a plan
Once you've completed your application, you're ready to choose a plan. The website will display all the available plan options within four metallic tiers: bronze, silver, gold, and platinum.
A bronze plan will generally have the lowest monthly premium, but you'll pay more out-of-pocket when you receive medical care. This could be a good option if you don't plan on needing a lot of medical services, but want coverage if you're in an accident.
Conversely, a platinum plan will generally have the highest monthly premium costs, but you'll pay the least when you receive medical services. This could be a good option if you have a lot of medical needs or visit your doctor often.
It's important to note that these metal tiers have nothing to do with the quality of care you'll receive. They simply determine how you and your health insurance company will split your healthcare costs.
If you're worried about choosing a plan on your own, HealthCare.gov has a number you can call3 to talk with a professional for free. If your employer administers your HRA with PeopleKeep, you can get even more help with Stride Health4.
Stride Health is an online tool you can use to get a personalized health insurance policy recommendation. You can search for the lowest-priced policies in your area and learn if you qualify for premium tax subsidies, making your search through affordable health insurance options quick and easy.
Step 4: Pay your first premium
All health plans are “guaranteed-issue,” meaning all eligible individuals are accepted no matter what, so you won't need to wait and see if your plan is accepted.
Once you select a plan, you'll make your first payment before your coverage officially starts. In most cases, you'll be transferred from the Marketplace to your health insurance company's website to enter your credit card information for your first payment. Or, the Marketplace will bill you for your premium and forward the payment to your insurance carrier.
Once purchased, you'll receive an insurance card and documents by mail. Even if you leave your current job, your plan will stay with you since it's not tied to your employment as it would be with a group health insurance plan.
Step 5: If your employer offers an HRA, submit your premium for reimbursement
If you have an HRA allowance from your employer through a qualified small employer HRA (QSEHRA) or an individual coverage HRA (ICHRA), your employer can reimburse you tax-free for your health insurance premiums and other qualifying medical expenses, such as prescription drug costs and certain medical equipment.
All you need to do is submit documentation to your employer that shows the following:
- The premium amount
- The coverage date
- The insurance provider
After your employer reviews and approves the documentation, you'll automatically get reimbursed every month up to your allowance amount. If your premium exceeds your monthly allowance, you'll simply pay what's left out of pocket.
Conclusion
It's easier than ever to find affordable health insurance coverage that meets your unique healthcare needs. There's no right or wrong answer when choosing your comprehensive health coverage through the Health Insurance Marketplace or a private exchange. Working with a licensed broker can help you during your search and get you enrolled in the right plan for you and your family situation.
Even better, if your employer is offering you an HRA, you can use your allowance to pay for your monthly premium and other healthcare expenses, making your individual health insurance policy even more affordable than you may think.
This article was originally published on July 8, 2021. It was last updated on September 7, 2023.
