Knowing how to pick an individual health plan can be confusing. Here are five steps to help you shop and enroll in a health plan that fits your lifestyle and your budget.
1. Know what you need
What is an individual health plan?
An individual health plan is one you select and purchase for yourself or your family, as opposed to one sponsored by an employer or other government-run programs like Medicaid or Medicare.
An individual health plan is one you buy for yourself or your family, not through an employer or government programs like Medicaid or Medicare.
Types of health plans:
- HMO: Requires using a network of doctors and facilities
- HSA: A tax-free savings account for medical expenses
- Narrow Network: Lower costs but limited to specific providers
- Metal levels: Bronze (low premiums, high out-of-pocket), Silver (balanced costs), Gold (high premiums, low out-of-pocket)
2. Determine your budget
How much does an individual health plan cost?
Many factors impact the costs of your health plan.
For example, if you live in an area with a narrow network option and agree to see only providers that are part of that narrow network, you could save money on your premium. Additionally, health plan rates are affected by your age, the size of your household and your coverage needs.
Cost factors include:
- Premium: The amount you pay monthly for your health plan and coverage.
- Deductible: The amount you pay each year before the health plan starts to pay for certain services. Deductibles generally vary by plan.
- Copay or coinsurance: The amount you pay at the time you receive a health care service. You may also have a copay when you get a prescription filled.
- Out-of-pocket maximum: The most you'll pay for covered services each year, including the deductible and coinsurance.
You may be eligible for a subsidy – a discount on your health plan costs based on your household size and income.
3. Check your eligibility for savings
What is a subsidy?
A subsidy is a discount on your monthly premium based on your household size and income, making your health care plan more affordable. It's also sometimes called an advanced premium tax credit (APTC).
How do I know if I qualify for a subsidy?
Subsidy eligibility and the amount you receive depends on several factors:
- Your estimated modified adjusted gross income (MAGI) for your household for the year you want coverage
- Your household size, which usually includes everyone you list on your tax return
- Where you live
- Your age
- If you use tobacco
When you shop for a MyPriority plan, we'll check if you qualify for subsidies. See if you're eligible for a subsidy.
What if I don't qualify for a subsidy?
Off Marketplace plans are an affordable option for those who don't qualify for a subsidy or choose not to use it. When you shop for a health plan, look for the Off Marketplace options, including Off Marketplace Narrow Network plans.
4. Enroll at the right time
Can I buy a health plan at any time?
You can only buy a health plan during the annual Open Enrollment Period (OEP) or if you qualify for a Special Enrollment Period (SEP). You may be eligible for a SEP if you experience a qualifying life event.
Examples of SEP qualifying life events include loss of essential coverage, loss of COBRA benefits, marriage, birth, permanent relocation, divorce, adoption, death of the previous policyholder, named a legal guardian, new foster child, change in citizenship and newly eligible for government assistance. A couple of things to note are:
- An unexpected medical event or injury does not qualify you to enroll in a health plan during a Special Enrollment Period.
- Depending on your specific circumstance, you're only allowed 60 days from the day of your qualifying life event to change or enroll in health insurance. If you don't take action by the deadline, you could find yourself without coverage until the next open enrollment period.
What does Open Enrollment mean?
The Open Enrollment Period is the annual period when you can enroll in a qualified health plan either through the Health Insurance Marketplace® or a private insurer like Priority Health.
How long is the Open Enrollment Period? When does it start?
The Open Enrollment Period is from Nov. 1 through Jan. 15 every year.
- Enroll by Dec. 15, and your coverage to start on Jan. 1
- Enroll by Jan. 15, and your coverage starts on Feb. 1
How does the Open Enrollment Period work?
During OEP, you can enroll yourself and your family in a health care plan for the following year.
You can purchase a plan from a trusted health plan company, like Priority Health, or through the Marketplace. You can also consult with a licensed agent if you would like more assistance choosing a plan.
Can I sign up for a health plan after the Open Enrollment Period?
If you miss the deadline, you won't be eligible for coverage unless you experience a qualifying life event (QLE) such as getting married, having a baby or moving to a new location. A QLE allows you to enroll during a Special Enrollment Period (SEP). Otherwise, you'll need to wait until the next OEP.
5. Choose the plan that's right for you
Save and send plans
See all Priority Health plans available to you by providing information about yourself and where you live. You can star the plans you would like to save and email them to yourself for when you are ready to enroll.
Speak with a Michigan-based enrollment specialist
Have questions or need some guidance? Our award-winning enrollment specialists can save time by helping you choose an Individual & family health plan.
Call us at 844.590.0836.
Frequently asked questions (FAQs)
Q. Are there Individual health plans for students?
A. Our specialists can help you with all the options available to college students. We understand that life as a student is busy!
Q. Can I change my Individual health plan at any time?
A. You choose your health plan during OEP for the following year. You can only change your health plan outside of OEP if you qualify for a SEP due to a life event like losing other coverage, getting married or having a baby. You usually have 60 days from the life event to enroll in a new plan, but you should report your change as soon as possible.
The Open Enrollment Period occurs from Nov. 1 through Jan. 15 every year.
Shop with confidence
- Video library
- 10 shopping mistakes to avoid
- 5-step guide to shopping
- Affordable Care Act key terms
- ACA myths and facts
- Financial health plan terms
- Final step for enrolling
- How to compare health plans
- OEP checklist
- Understand plan networks
The right coverage
- Take a quiz to find your plan
- Narrow Network plans
- What's a high-deductible plan?
- Understanding metal levels
- Health coverage for gig workers
- Coverage for immigrants
- Medi-Share health cost-sharing
Prioritize value
- 5 must haves in a plan
- Why choose a MyPriority plan?
- How to save on health coverage
- Chronic condition coverage
- MyPriority plan benefits