How to get help choosing an individual health insurance plan

Whether you’re enrolling in health coverage for the first time or switching your current plan, selecting an individual health insurance policy on your own can be difficult. Many individual health plans are available on public and private exchanges, such as through the federal and state marketplaces and insurance brokers. But how do you know which policy is right for you?

Choosing a health insurance plan doesn't have to be complicated or time-consuming. There are several resources and companies out there that can help you compare insurance policies, review network providers, and answer your questions and concerns.

In this blog post, you’ll learn:

• The five categories of individual health insurance plans, what they cover, and how they can impact your overall costs.
• How public health exchanges and their customer service teams can help you choose the right health plan for you and your family.
• How private exchanges and health insurance brokers offer personalized support to match you with health coverage that meets your needs and budget.

What is an individual health insurance plan?

An individual health insurance plan is a policy that individual consumers or families buy independently. This isn’t coverage you get through an employer, like traditional group health insurance. You can buy individual health plans directly from a health insurer, a broker, or a state or federal health insurance exchange, also known as a marketplace.

When purchasing an individual plan, you can select a policy with your preferred features, covered benefits, and metallic tier. This helps you tailor your plan to meet your and your family’s medical needs, ensuring you get exactly what you want. Additionally, compared to employer-sponsored group health plans, many individual policies tend to be more affordable.

For example, in Cleveland, a bronze small group plan can run $670.93 per month on average for a 40-year-old in 2026, compared to just $321.19 on average for an individual plan¹.

You can purchase supplemental or ancillary plans, such as dental, vision, and disability insurance, on an individual basis. An employer may not offer these policies as part of their benefits package, so individuals are often responsible for choosing and paying for them on their own.

Lastly, individual plans aren’t dependent on employment. You can keep your policy as long as you like, provided you continue to pay the monthly premium to keep the plan active.

What are the five categories of individual health plans?

When shopping for individual health coverage, it’s crucial to know basic health insurance terminology. You’re probably familiar with the various plan types available on the individual market. However, there are also five health plan categories, or metal tiers, that define the policies available on public exchanges.

The plan categories are catastrophic, bronze, silver, gold, and platinum. The higher the category level, the more the insurance company pays toward your healthcare expenses on average. The lower the level, the less the insurer will pay on average. This reflects the plan’s actuarial value.

On the other hand, the higher the tier, the higher your monthly premium amount. It’s also important to note that your chosen tier doesn’t impact your quality of care.

The following shows the approximate share of medical expenses a health plan will cover compared with what you can expect to cover with each type of plan:

• Bronze: You pay 40%, and the health insurance issuer pays 60%.
• Silver: You pay 30%, and the insurer pays 70%.
• Gold: You pay 20%, and the insurance carrier pays 80%.
• Platinum: You pay 10%, and the health insurance provider pays 90%.

According to the Affordable Care Act (ACA), all marketplace health plans must cover the ten essential health benefits. Additionally, tiers can have plans in any type of network. For example, there are gold-tier health maintenance organization (HMO) plans and gold preferred provider organization (PPO) plans.

If you qualify, you also have the option to purchase a catastrophic plan. These plans offer those who meet specific criteria, generally those younger than 30, more affordable premiums in exchange for a higher annual deductible. However, once you reach the deductible, the plan usually covers 100% of essential health benefits.

How much does individual health insurance cost?

According to KFF, the national average monthly premium for a benchmark ACA plan in 2026 was $625.² A benchmark policy is the second-lowest-cost silver plan available on public marketplaces.

The average monthly cost of individual health insurance can vary depending on various factors, such as:

• Age
• Geographic location
• Family status (whether you’re buying coverage for yourself or including dependents)
• Tobacco use
• Metal level type

Due to the ACA, a health insurer can no longer determine your price based on gender or a pre-existing medical condition.

While your monthly premium is an important cost to consider, it's only one part of what you'll pay for healthcare. You'll also want to compare each plan's cost-sharing amounts, which are the policy’s deductible, copays, and coinsurance. Looking at all of these costs together can help you choose a plan that best fits your needs and budget.

“Consider what will really impact your day-to-day life,” said Eric Testa, PeopleKeep Benefits Advisor. “For most people, the cost of their prescription drugs and the copay amounts for urgent care and specialist visits are crucial. People often overlook the phrase ‘after deductible’ on their Summary of Benefits. It’s usually ideal to find a plan with many fixed copay amounts instead of plans that make you reach your deductible before the carrier offers support.”

Lastly, depending on your annual income level and other factors, you may qualify for premium tax credits and other federal government subsidies through the public marketplaces to help make individual coverage more affordable. However, you can’t receive a federal subsidy if you shop for a policy on a private health exchange.

If your employer offers you an affordable contribution through a health reimbursement arrangement (HRA), this can also impact your subsidy eligibility.

Who should purchase individual health insurance?

You may think you don't need health insurance if you’re young and healthy. But that’s not a good guideline to follow.

You should consider purchasing your own individual health insurance plan if:

• You’re self-employed.
• You’re a small business owner.
• You’re turning 26 and aging off of your parents’ health insurance policy.
• Your job doesn’t provide employer-sponsored health insurance.
• Your employer offers you a stand-alone health reimbursement arrangement (HRA), such as a qualified small employer HRA (QSEHRA) or an individual coverage HRA (ICHRA).

Healthcare costs can be expensive, especially if you need emergency care. For example, the average cost of an inpatient hospital stay for treating heart disease is about $21,560.³ If you don’t have the money to pay the out-of-pocket costs that come with unexpected medical bills or treatment for chronic diseases, you can quickly find yourself in serious medical debt.

An individual health insurance policy can cushion the blow if you experience a medical crisis or need urgent care. Some policies, such as a high deductible health plan (HDHP) or a bronze plan, typically have lower monthly premiums. So, affording an individual plan can be more cost-effective than you think.

“Try to anticipate your upcoming year,” Testa said. “Have you been generally healthy? If so, maybe a low-premium, high deductible plan is best for your family. Are you going into the year knowing you have a surgery or other high-cost items coming up? If that’s the case, consider a higher premium plan that will have a lower deductible and lower maximum out-of-pocket.”

If your employer offers an alternative type of health benefit, you may also want to purchase an individual plan. Suppose your employer offers you a QSEHRA or an ICHRA. In that case, you’ll need a qualifying medical plan that meets minimum essential coverage (MEC) to participate in the benefit. Enrolling in a qualified individual health insurance plan will help you meet this requirement.

With a QSEHRA or ICHRA, your employer’s contribution will help you pay for your individual health insurance premiums, lowering your healthcare costs.

Ways you can get help shopping for individual health insurance

If you’re ready to shop for individual health insurance, you may be wary if it’s your first time. But finding the right policy can be easier than you think. There are many cutting-edge technologies to help you browse, compare, and enroll in coverage in no time.

The following platforms and experts offer assistance and resources to help you choose the right individual health plan.

Public health exchanges

A public health exchange is a marketplace operated by the federal government, a state government, or a government-contracted entity. Common public exchanges are the federal Health Insurance Marketplace and state-based Marketplaces.

Public exchanges enable individuals to conveniently shop, compare, and enroll in a qualified health plan online or by phone, with personalized help from licensed enrollment assistants called navigators. They aren’t associated with a specific type of health insurance or carrier. So, they’ll provide you with unbiased assistance.

Shoppers can find the right health plan for themselves by filtering by:

• Budget
• Preferred healthcare providers
• ZIP code
• Healthcare services and other plan benefits
• Health insurance company

You can also find out if you’re eligible for premium tax credits and other subsidies on public marketplaces. If you have questions, public exchanges also offer free customer support options.

Private health exchanges

Private health insurance exchanges include platforms operated by insurance companies, benefits technology vendors, and licensed brokers. While public exchanges only offer ACA-compliant health plans, private exchanges can offer ACA-compliant plans as well as other types, such as supplemental and ancillary plans. This means you can shop for all the coverage you need, all in one convenient location.

Off-exchange individual health plans might come with household income eligibility thresholds for participants. Therefore, consider working with a broker to ensure you select the best plan possible.

Brokers have a wealth of experience dealing with insurers and have extensive knowledge of a wide range of health plans. They work with you directly to find affordable health insurance coverage for you and your eligible family members.

Once you find the health plan you want, you can enroll through your agent or broker rather than the insurance company. But remember, if you enroll in a plan on a private exchange, you won’t be eligible for any cost-sharing reductions or premium tax credits that may be available if you shop on a public marketplace.

Healthcare shopping companies

The last way you can get help choosing an individual health plan is through a healthcare shopping company. These private companies make it easier to compare plans, understand your options, and enroll in coverage that fits your medical needs and healthcare budget. Many also provide year-round support if you need help with your coverage after enrollment.

Healthcare shopping companies often help you compare health insurance plans from multiple carriers in one place. You can also filter plans based on your preferred doctors, prescription drugs, budget, and coverage needs. Whether online or over the phone, these companies provide personalized insurance solutions and enrollment support as well as ongoing customer service year-round.

Below are a few popular companies that can help you shop for individual health:

• PeopleKeep by Remodel Health: If your employer offers a stand-alone HRA, such as a QSEHRA or an ICHRA, through PeopleKeep, you can shop for individual health insurance directly from your employee dashboard. The platform helps you compare qualifying plans, find coverage that works with your HRA, and enroll in a policy that allows you to receive tax-free reimbursements for qualified out-of-pocket costs.
• Every member with a PeopleKeep QSEHRA or ICHRA also receives access to a complimentary benefit advisement with a licensed benefits advisor. Scheduling an advisement is a great way to get personalized guidance and compare plan options, so you’re prepared for Open Enrollment or a special enrollment period.
• Stride Health: This company helps individuals compare ACA plans and other insurance products with personalized recommendations.
• GetInsured: This organization provides a digital marketplace where consumers can shop for and enroll in individual health insurance plans.
• HealthSherpa: The team at HealthSherpa offers a private enrollment platform that helps individuals compare Marketplace plans and enroll in ACA coverage. While consumers can’t enroll via HealthSherpa directly, they can work with a broker or carrier that uses the platform for enrollment.

Conclusion

There’s no right or wrong answer when it comes to picking the perfect individual health insurance policy. The public or private health exchange can help you find individual coverage. However, a broker or a personalized healthcare shopping company can also help you compare plan options, optimize health savings, and guide you through the enrollment process.

Though health insurance can be confusing initially, it's essential for your overall health and well-being in the long run, especially if you have a medical emergency. Luckily, there are experts and organizations waiting to help you get the type of health plan you need.

This article was originally published on June 1, 2022. It was last updated on August 7, 2026.

References

1. Ideon ICHRA Market Insights

2. KFF - Average Marketplace Premiums by Metal Tier

3. TCTMD - Heart Disease Treatment Costs $100 Billion per Year in the US