Individual health insurance is a policy you purchase on your own rather than receiving through an employer. You can buy individual plans through your state's health insurance marketplace or directly from insurance carriers. Marketplace plans may qualify for premium tax credits and cost-sharing reductions based on your household income, making comprehensive coverage affordable for many people who do not have employer-sponsored insurance.
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Who needs individual health?
Individual health insurance is essential for the self-employed, freelancers, gig workers, small business owners who cannot form a group, early retirees not yet eligible for Medicare, and anyone between jobs. In areas where small businesses and self-employment are common, individual marketplace plans are often the primary coverage option. If your household income is between 100% and 400% of the federal poverty level, you likely qualify for premium subsidies; enhanced subsidies extended through recent legislation have made even higher earners eligible for assistance. Open enrollment typically runs from November 1 through January 15 annually, and the Way Agency helps clients navigate plan selection, subsidy calculations, and enrollment every year.
What does individual health cover?
- All ACA essential health benefits: hospitalization, prescriptions, maternity, mental health, preventive care
- Preventive services with no cost-sharing (annual physicals, cancer screenings, immunizations)
- Emergency and urgent care services
- Prescription drugs (formulary varies by plan and metal tier)
- Mental health and substance abuse services
- Rehabilitative services and devices
- Lab work and imaging
- Pediatric dental and vision for children under 19
What individual health does NOT cover
- Adult dental and vision (available as separate standalone plans)
- Cosmetic surgery
- Long-term care or custodial nursing facility care
- Care outside the plan's provider network (HMO plans) or at higher cost (PPO plans)
- Experimental treatments not approved by the plan
- Non-emergency care outside the U.S.
What does individual health cost?
Monthly premiums for individual plans vary widely by metal tier: Bronze plans (lowest premium, highest deductible) start around $250 to $350 per month for a 40-year-old before subsidies, while Gold plans run $450 to $650. With premium tax credits, many people pay significantly less. A 40-year-old earning $35,000 might pay $100 to $200 per month after subsidies. Silver plans are often the best value because they unlock cost-sharing reductions for those earning under 250% FPL, lowering deductibles and copays substantially. The Way Agency runs actual subsidy calculations before recommending a metal tier, because the cheapest premium is not always the cheapest total cost of care.
Frequently asked questions
The annual Open Enrollment Period typically runs from November 1 through January 15. Outside of open enrollment, you can only enroll during a Special Enrollment Period triggered by a qualifying life event such as losing other coverage, getting married, having a baby, or moving to a new area. Medicaid and CHIP enrollment is available year-round.
Premium tax credits are based on your household income relative to the federal poverty level. If your income is between 100% and 400% FPL, you likely qualify, and enhanced subsidies currently extend assistance to higher earners as well. For a single person in 2026, 400% FPL is approximately $60,240. The Way Agency can estimate your subsidy amount before you apply by reviewing your expected annual income.
The metal tiers reflect how costs are shared between you and the insurer. Bronze plans cover about 60% of costs (low premiums, high deductibles). Silver covers 70% and unlocks extra cost-sharing reductions for lower-income enrollees. Gold covers 80% with moderate premiums and lower out-of-pocket costs. Platinum covers 90% with the highest premiums but lowest cost at the point of care. All tiers cover the same essential benefits.
Yes. You can purchase individual health plans directly from carriers without going through your state's marketplace. However, if you buy off-marketplace, you cannot receive premium tax credits or cost-sharing reductions. For most people who qualify for subsidies, buying through the marketplace saves significant money. The Way Agency helps determine whether on- or off-marketplace enrollment is the better path.
You would be uninsured until the next open enrollment period or until you experience a qualifying life event. In many states, short-term health plans are available as temporary gap coverage but do not cover pre-existing conditions and are not ACA-compliant. Going without coverage carries financial risk but there is currently no federal penalty for being uninsured. The Way Agency strongly recommends enrolling during open enrollment to avoid gaps.
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Related coverage to consider
- Family Health - Covers you, your spouse, and dependent children under one policy.
- Supplemental Health - Pays cash benefits directly to you when a covered health event occurs - accident, critical illness, or hospital stay.
- Dental, Vision & Hearing - Most health insurance plans do not include dental, vision, or hearing coverage for adults.
- Disability Insurance - Replaces a portion of your income (typically 50–70%) if you're unable to work due to illness or injury.
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Reviewed by
Sheilia Royal, Agency Principal / Licensed Agent
Licensed in KY, IN & TN | 20 years experience | Last reviewed: March 2026