These plans are available to anyone 18 years and older who does not receive coverage through their employer but makes too much annually to be eligible for government assistance through Medicaid.
While it can be confusing to hear all of these various names, they are all referring to the same type of health insurance plan that is available to individuals over the age of 18 who do not qualify for Medicaid or employer coverage:
Open enrollment occurs each year from November 1 through January 15. During this time, anyone can enroll in an individual and family plan. Outside of this open enrollment period, you can buy a plan if you have a qualifying event, such as marriage or moving to a new home. Learn more about these enrollment events on our special enrollment page.
Learn more about ACA plans on SSM Health’s Weekend Wellness Podcast.
A Marketplace plan, or exchange plan, is a plan offered on healthcare.gov. These plans offer financial subsidies and tax credits, so to apply you will need to enter your annual income when applying to find out if you qualify for any of these assistance programs. These plans can also be purchased with the assistance of a licensed insurance agent, but are the only plans to offer financial assistance to those who qualify.
A direct, or off-exchange plan, is a health insurance policy that is purchased directly from an insurer or through an agent or broker, outside of the Marketplace. These plans do not offer any financial subsidies or tax credits, but some may offer additional benefits you cannot receive on a Marketplace plan.
All Individual & family plans are divided into metal categories. These categories show how you and your plan share costs. No matter which category your plan falls in, the quality of care does not change.
Bronze plans are best if you do not typically need to see your doctor or use your prescription coverage very often. The monthly premium payment will be lower, but when you do need care, your out-of-pocket costs will be higher.
Silver plans have your out-of-pocket costs and your monthly premiums more evenly balanced. These plans are beneficial if you may use your health care for more than just preventive care.
Gold plans are ideal and cost-efficient if you anticipate going to your provider or pharmacy frequently. These plans will have a higher monthly premium payment, but your out-of-pocket costs will be lower.
Depending on your income and personal situation, you may be eligible for a variety of discounts and subsidies, too. Using the Health Insurance Marketplace Calculator, you can find out if you qualify. Find for more information and to find out if you are eligible.
All individual and family plans must cover a set of 10 categories of services under the Affordable Care Act (ACA). These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Learn more about what ACA plans are required to cover.
There are several ways you can enroll in a plan, both online or in-person with a licensed health insurance agent. Learn more about Individual & Family plan enrollment.