Individual Health Coverage

Statistically, about 1 in 2 Americans get their health insurance through their employer. For everybody else, an individual health insurance plan is likely their best option. If you’re looking for information on individual health insurance plans, then look no further; this is a one stop shop for all your needs.

Individual Health Insurance Keywords

  • Premium: A monthly payment you have to make to keep your insurance plan.
  • Deductible: The amount of money you have to pay on your own for your medical needs before your insurance will start assisting. This will be an annual amount. (If you want a more in-depth explanation of deductibles, then read our article "Understanding Your Deductible").
  • Copay: A flat rate you pay per health service, like $10 per doctor’s visit or $5 per bottle of medication. Your insurance will cover the rest.
  • Coinsurance: A percentage you pay for the cost of each health service. For example, on a 10% coinsurance plan you would pay 10% of each doctor visit, medical procedure, etc. before your insurance covered the rest.


Types of Individual Health Insurance Plans

Individual health insurance plans all fall into one of several categories: Health maintenance organizations, exclusive provider organizations, preferred provider organizations, and point-of-service plans.

  • Health Maintenance Organizations (HMOs): HMOs will give you a network of doctors, specialists, etc. that you can go to for your medical needs. If you have an HMO, then you will be required to choose a primary care physician to cover most of your medical needs. If you need to see a specialist, then your primary care physician will give you a referral for a specialist that is in your network.
  • Exclusive Provider Organizations (EPOs): EPOs will also give you a network of doctors, specialists, etc. Depending on your plan, seeing a doctor or specialist that is out-of-network may not be covered. Your EPO may or may not require you to have a primary care physician, but none of them require referrals to see a specialist.
  • Preferred Provider Organizations (PPOs): PPOs typically offer a wider care network than their EPO or HMO counterparts. The downside, however, is that they typically have higher premiums (and, therefore, are more expensive) to compensate. Like EPOs, PPOs normally do not require you to have a primary care provider and do not require a referral to visit a specialist. You can even see an out-of-network specialist (albeit at a higher cost). Click here for a more in-depth breakdown of HMOs vs PPOs.
  • Point-of-Service Plans (POS): POS plans are a hybrid of HMO and PPO plans. The care networks are smaller than a PPO plan, but the premiums are lower to match. You are required to have a primary care physician and need their referral to see a specialist. However, if you can see an out-of-network specialist if you choose to; the cost would be higher, but not as high as if you had to pay entirely out-of-pocket.

When You Can and Can’t Buy Health Insurance

Whether or not you can buy health insurance at any point depends. Normally, you can only enroll during an Open Enrollment period; for Marketplace health insurance, this is typically from November - December. However, you can sign up anytime if you have a qualifying life event.

Qualifying Life Events

  • Loss of Health Coverage: If you age out of a parent’s plan, lose your employer-based plan, no longer qualify for a student plan, or lose your current coverage for any other reason.
  • Change in Household: If someone in your household gets married/divorced, adopts a child, or dies.
  • Change in Residence: If you change ZIP code, move to/from seasonal work or school, or move to/from a shelter or other transitional housing
  • Other Qualifying Events: If you experience a significant change in income, gain federally recognized tribal membership, leave incarceration, and more.


These are some of the most common qualifying life events, but not all of them. For a full list of qualifying life events, visit

Short-term Health Plans                                                                    

If you are temporarily in-between jobs or in a new and different location, then it would be smart to consider a short-term health plan. Short term plans only apply for a few months (the maximum length of time they can cover varies by state). Short-term health plans offer less comprehensive cover than termless health plans; however, for people without insurance or a qualifying life event, they can provide an important safety net.

Individual vs Group Coverage

There are many similarities between individual vs. group health insurance, but there are some key differences.

If you get your health insurance through your employer, then you have a type of insurance called small-group coverage, or group insurance. In this case, you’ll split the cost of your premiums with your employer.

If you’re self-employed, unemployed, or have an employer that doesn’t offer you group coverage, then you’ll need individual coverage, or individual health insurance. Individual health insurance is typically more expensive per person than group health insurance. However, individual coverage plans allow you to shop around to plans with different coverage networks, in-network physicians, and more.

Handle Your Finances

Health insurance can be expensive. If you're worried about debt, then read our Top 5 Tips to Avoid Medical Debt. Or, you can fill out our contact form to get in touch with an agent today. They may be able to help you pay less for better coverage, so don't wait.