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Personal Health Insurance - You Have to Know

Buying private health insurance

If your employer does not provide you with health insurance through the benefits program, you may consider purchasing your own health insurance from a private health insurance company.

The premium is the amount an individual or company pays to an insurance company to cover it. Health insurance premiums are usually paid monthly. Usually, employers who offer an employer-sponsored health insurance plan cover a portion of the premiums. If you need to insure yourself, you will pay the full cost of insurance premiums.

It is common to worry about the cost of purchasing health insurance for yourself. However, you have different options and prices depending on the level of coverage you need.

When purchasing your own insurance, the process is more complicated than simply choosing a company plan and getting premium payments that come directly from your paycheck each month. Here are some tips to guide you through the process of purchasing your health insurance.

Key points to remember

  • You may need to purchase Individual Medical Coverage if you have just turned 26, are unemployed or self-employed, working part-time, starting a business with employees, or have recently retired.
  • If you do not have the option to enroll in an employer-sponsored health insurance plan, one good source for obtaining insurance coverage is the health insurance marketplace created in 2014 under the Health Insurance Act. Affordable Care (ACA).
  • If you are at least 65 years old or disabled, you can enroll in Medicare, with the option to add additional coverage through a Medigap plan or a private Medicare Advantage plan.

How does buying private health insurance work?

Some Americans obtain insurance by signing up for a group health insurance plan through their employer.

Medicare provides medical coverage for the elderly and disabled, and Medicaid covers low-income Americans.

Medicare is a federal health insurance program for people aged 65 or older. Some young adults with disabilities and people with end-stage kidney disease may also be eligible for medical care. Medicaid is a generally subsidized health care program for low-income Americans, regardless of age.

If your company does not offer an employer-sponsored plan and you do not qualify for Medicare or Medicaid, individuals and families have the option of purchasing insurance policies directly from private insurance companies or through the health insurance marketplace.

Scenarios in which you may need private health insurance

There are certain circumstances that increase the likelihood that you will need to purchase your own health insurance plan, including:

A young adult of 26 years of age or older

Under the provisions of the Affordable Care Act (ACA) 2010, young people can be covered as dependents under their parent's health insurance policy up to age 26. Next, they have to look for their insurance policy.


If you lose your job, you may be eligible to maintain coverage through your employer's health insurance plan for a period of time through a program called the Uniform Comprehensive Budget Adjustment Act (COBRA). COBRA offers eligible employees and their dependents the ability to maintain health insurance coverage at their own expense.

Although coverage through COBRA can be maintained for up to 36 months (under certain conditions), the cost of registering with COBRA is very high. In fact, the ex-employee pays the entire cost of the insurance. Usually, employers pay a portion of health care premiums on behalf of their employees.

Part-Time Employee

Part-time jobs rarely offer health benefits. A part-time job is one that requires employees to work fewer hours than the employer considers to be full-time or 40 hours per week. If you work part-time, you will usually have to have your own health insurance.


A self-employed person can be self-employed or own a business. Some self-employed people can get health insurance through a spouse plan. Otherwise, they must provide their own health insurance.

A business owner with employees

If you are starting a business and have employees, you may need to provide them with health insurance. Although it is not required, it was decided to offer health insurance to be a competitive employer capable of attracting qualified candidates. In this case, you will need to subscribe to the company's health insurance plan, also called a group plan.

If you retire (or your spouse/father has retired)

When you retire, you will likely not be eligible for employer-sponsored health insurance. If you are under 65 and not disabled, you will need to purchase private individual health insurance until age 65 and can apply for health insurance. Many retirees choose to purchase private Medigap or Medicare Advantage plans in addition to Medicare to ensure more comprehensive coverage. Some retirees may also decide to replace their entire Medicare coverage with a private Medicare Advantage plan.

It's important to note that Medicare, Medigap, and Medicare Advantage plans are for individuals only—your spouse, partner, and any dependents cannot be insured through your Medicare plan. This means that if your family was previously covered by your employer's plan and you retire, your family members may need to purchase individual insurance plans.

Abandoned by the current insurance company

Although the ACA prohibits insurance companies from revoking your coverage or denying you coverage because of a pre-existing condition or because you made a mistake in your claim, there are other circumstances in which your coverage may be revoked. It is also possible for your insurance to become too expensive to afford.

Why should you buy health insurance?

If you find yourself in one of the situations listed above and you are not covered by health insurance, it is important that you develop an individual plan as soon as possible. (The penalty for not getting coverage was waived in 2019).

Although you are not required to have insurance, you cannot predict when an accident will require medical attention. Even a minor break can have major financial consequences if you don't have insurance.

If you purchase insurance through the Health Insurance Marketplace, you may qualify for premium income-tested tax credits or cost-sharing reductions. The marketplace is a platform that offers insurance plans for individuals, families, and small businesses.

The ACA created the marketplace as a way to maximize compliance with the mandate that all Americans are enrolled in health insurance. Many states offer their own markets, while the federal government operates an exchange open to residents.

While you can't afford the same type of plan your employer would, any amount of coverage is better than none. In the event of a serious accident or prolonged illness, you will be prepared.

Choosing the best insurance plan for you

There are several types of health insurance plans, and each of these plans has a number of unique features.

Health Maintenance Organization (HMO)

A health maintenance organization (HMO) is a company with an organizational structure that allows it to provide insurance coverage to its subscribers through a defined network of health care providers.

Typical HMO features include paying for insurance coverage for a monthly or annual fee. Premiums tend to be lower for HMOs because health providers refer patients to them, but the downside is that subscribers are limited to accessing a network of doctors and other health care providers under contract with the HMO.

Preferred Provider Organization (PPO)

A preferred provider organization (PPO) is a type of insurance plan in which health care professionals and facilities provide services to subscribing clients at discounted rates. The health care providers that are part of this network are called preferred providers or providers within the network.

Subscribers to a PPO plan have the ability to see health care providers outside of this network of providers (out-of-network providers), but the rates for seeing these providers are more expensive.

Sole Supplier Organization (EPO)

Exclusive Provider Organization (EPO) is a combination of HMO and PPO plans. With an EPO scheme, you can only receive services from providers within a particular network. However, exceptions can be made for emergency care.

Another advantage of the EPO scheme is that you may need to choose a primary care physician (PCP). This is a general practitioner who will give you preventive care and treat you for minor ailments. Also, with an EMO plan, you generally don't need to get a referral from your PCP to see a medical professional.

High Deductible Health Plan (HDHP)

The High Deductible Health Plan (HDHP) has some key features. As the name suggests, it has a higher annual discount than other insurance plans. The discount is the part of the insurance claim covered by the underwriter himself. HDHP programs generally have lower monthly premiums.

This type of plan is ideal for young people or generally healthy people who do not expect to seek health care services unless they experience a medical emergency or an unexpected accident.

The final defining advantage of a high-deductible health plan is that it provides access to a tax-advantaged Health Savings Account (HSA).

HSA subscribers can contribute funds that can then be used for medical expenses not covered by the HDHP. The advantage of these accounts is that the funds are not subject to federal income tax when they are deposited.

Consumer Driven Health Plan (CHDP)

Consumer-driven health plans (CDHPs) are a type of HDHP. Payment for a portion of the services subscribers receive is made in pre-tax dollars. Like other HDHP programs, CDHP has higher annual deductibles than other health insurance plans, but the subscriber pays lower premiums each month.

Point of Service (POS) Plan

A Point of Service (POS) plan offers different benefits to subscribers depending on whether or not they use Preferred Providers (Network Providers) or Preferred Out-of-Network Providers (Out-Network Providers). The POS plan includes the features of the HMO and PPO plans.

Short Term Insurance Policy

The short-term insurance policy covers any gaps in coverage that you may encounter if, for example, you change your job and your new business plan doesn't go into effect immediately.

It usually lasts three months. Term lengths vary by state, and in some US states, you may qualify for a short-term plan of up to 12 months.

Short-term health insurance is also called temporary health insurance or temporary health insurance. This can be useful if you've changed jobs, waited to become eligible for Medicare coverage, or waited for a specific open enrollment period for a plan

Under the short-term insurance plan, your spouse and other eligible dependents may also be covered. However, an important caveat to a short-term insurance plan is that in some cases, pre-existing conditions may exclude you from coverage. The definition of a pre-existing condition varies depending on which condition you live in, but it is generally defined as something you've been diagnosed with or received treatment for within the past two to five years.

Disastrous Coverage

Catastrophic illness insurance is a type of insurance plan generally available only to adults age 30 or younger. To qualify, you must obtain a hardship exemption from the government. Catastrophic health insurance usually has lower premiums than other health insurance plans.

These types of plans are for people who can't spend a lot of money each month on premiums but don't want to be left without insurance in the event of an accident or serious illness.

Although catastrophic health insurance plans may have low monthly premiums, they generally have the highest deductibles possible.

Choose Franchise

Once you've decided what type of plan is right for you, you'll need to know how much you can pay as a deduction. This is the predetermined amount you pay for covered health services before your insurance plan starts paying.

What can you pay each year in personal medical expenses? With most health insurance plans, the higher the deductible, the lower your monthly premium. If your monthly cash flow is low, you may need to choose a higher discount.

Another major consideration when choosing an insurance plan is the maximum plan amount. Once you spend that amount on deductibles and medical services through co-pays and coinsurance, your health plan will pay the full cost of your covered benefits.

How much does private health insurance cost?

While many people are afraid of the prospect of purchasing their own insurance rather than enrolling in an employer-sponsored plan, some studies have shown that it may end up being more expensive than employer-sponsored plans.

A Kaiser Family Foundation study found that the average monthly premium for an employer-sponsored insurance plan for individual coverage in 2021 was about $645 and $1,850 for family coverage.

 If you had to purchase your own insurance outside of an employer-sponsored plan, the average cost of individual health insurance was $438. For families, the average monthly premium was $1,168.

Additionally, if you end up purchasing coverage through the health insurance marketplace, you may qualify for a cost-sharing reduction grant and advanced tax credits. These amounts can reduce your premiums, your deductible, and any co-payments and co-insurance that you are responsible for.

Where do I go to buy private health insurance?

There are many options available to you when it comes to purchasing private health insurance.


If you are retired (or soon to be), you can get started on the Medicare website. It is recommended to find out what the Standard Medicare plan covers and then review options for Medicare supplements through Medigap and Medicare Advantage policies.

When considering Medigap or Medicare Advantage coverage, it is important to understand how the two types of coverage work alongside standard Medicare coverage.


À la suite de l'ACA, le marché de l'assurance maladie a été créé en 2014. Vous pouvez visiter le site Web du marché de l'assurance maladie pour en savoir plus sur les options de couverture d'assurance maladie disponibles là où You live. You can also find out if you are eligible for and apply for a scholarship.

The market has a fixed period for open listing. This is usually from November 1 to December 15 each year, although various events may cause the open enrollment period to be extended or reopened.

The website includes information about special plans available for off-market purchases. However, if you purchase an off-market plan, whether during open enrollment or not, you will not be eligible for grants available under the ACA.

Under certain circumstances, an individual may be eligible to purchase a health care plan through an exchange even if they are outside the specified open enrollment period. This is called the special registration period. You may qualify for a special enrollment period if you experience a change in the family, including marriage or divorce, having or adopting a child, death in your family, moving home, losing health insurance, national disaster, or disability.

Private health insurance companies

You can visit the websites of major health insurance companies in your geographic area and browse the options available based on the type of coverage you prefer and the deductible you can afford.

The types of plans available and premiums vary depending on where you live and your age. It is important to note that the plan price listed on the website is the lowest price available for this plan and assumes that you are in excellent health. You won't know what you will actually pay each month until you apply and provide the insurance company with your medical history.

The price and type of coverage can vary greatly depending on the health insurance company. For this reason, it can be really difficult to compare plans to determine which company has the best combination of pricing and coverage. It can be a good idea to determine which plans offer most of the features you need and are within your price range, and then read consumer reviews of those plans.

If you are choosing a family plan or if you are a business owner choosing a plan that you will offer to your employees, you will also need to consider the needs of others that will be covered by the plan.

The Main Factors For Choosing a Plan

Health insurance plans offer a variety of different features. Although it can be difficult to find a plan that offers everything you want, consider which of the following features are the most medically and financially necessary. Here are some questions to consider when looking for charts:

  • Does the plan provide coverage for prescription drugs? Does it only cover generic versions of prescription drugs? What is a co-pay (also called a co-pay) on generic and brand-name drugs? Check the medications you are already taking, if any.
  • What is the co-pay for an office visits and did the plan specify the maximum number of office visits it will cover in a year?
  • What is the co-pay for specialized services such as X-rays, lab tests, and surgery? How about a visit to the emergency room?
  • Want a plan that allows you to add vision and dental coverage?
  • Do you need pregnancy benefits?
  • Do you already have a doctor you love? If so, you may want to find a plan that includes your doctor in their insurance company's provider network.
  • Do maximum lifetime and annual benefits apply? The ACA has effectively eliminated the lifetime maximum and annual maximum for basic medical services, but that doesn't include dental and vision coverage, for example.
  • Does the plan offer free or discounted preventive care services, such as an annual health checkup? Most ACA plans offer free coverage for most preventive care services. Short-term insurance plans and catastrophic coverage may not be.
  • Does the plan cover specialized services such as physical therapy, chiropractic, and acupuncture visits?
  • What hospitals are included in the network?
  • For PPOs, how much do out-of-network services cost, and do you want them or need them? Can you bear it?

When can I buy private health insurance?

Most types of health insurance have an open enrollment period during which you can purchase private health insurance. This is true whether you purchased insurance through your state's Affordable Care Act (ACA) health insurance exchange, whether you signed up directly with the insurance company, whether you signed up for the plan offered by your employer or whether you signed up for Medicare.

Certain life events may trigger a special enrollment period, which will allow you to change your health insurance coverage outside of your regular enrollment period. These events include marriage or divorce, having a child, losing work-based health insurance, or leaving your health plan's service area.


Getting your own health insurance policy isn't as easy as signing up for an employer plan, but at least you have control over which plan you get. Once you understand what you need and familiarize yourself with the terms used to describe health insurance plans, your search will become easier. With the number of options available, you can most likely find a plan that meets your needs and budget.

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