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.
Health plan types
An HMO is a type of health plan that provides care through a designated network of doctors, specialists and facilities that you must use in order to be covered by the plan.
A tax-free savings account used only for medical costs, an HSA is where you keep funds that you and possibly your employer contribute to pay for care and qualified medical supplies out of pocket. Similar to a retirement account, the funds are yours to own and manage.
Narrow network health plans require you to get care in a network of doctors, hospitals, labs and outpatient facilities in exchange for lower costs. Narrow network eligibility is based on your location and the health care systems in your area. If you receive care outside of your specific narrow network you may be responsible for all costs.
Our health plans have three tier levels corresponding to cost: bronze, silver, and gold.
- Bronze plans typically have lower premium costs but higher out-of-pocket costs at time of service.
- Silver plans offer a good balance of premium and out-of-pocket costs.
- Gold plans have higher premiums but lower out-of-pocket costs at time of service.
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. Finally, you may be eligible for subsidy–a discount on your health plan costs based on your household income.
Health plan costs
The amount you pay, usually monthly, for your health plan and coverage.
The amount you pay each year before the health plan starts to pay for certain services. Deductibles generally vary by plan.
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.
The most a plan member will pay for covered services each year, including the deductible and coinsurance. Your annual maximum cost.
3. Check your eligibility for savings
What's a subsidy?
A subsidy is simply a discount on your monthly premium based on your household income, making your health care plan more affordable. It is sometimes also referred to as advanced premium tax credit (APTC).
How do I know if I qualify for a subsidy?
Subsidy eligibility depends on household income, your household size and where you live. When you shop for a health plan, you can find out if you qualify for premium tax credits to make your plan more affordable.
See plans and prices to check if you're eligible for a subsidy.
What if I don't qualify for a subsidy?
Off-Marketplace (full or narrow network) plans are an affordable option for those who don't qualify for a subsidy or choose not to use it.
4. Enroll at the right time
What does open enrollment mean?
The open enrollment period, also known as OEP, is the annual period of time when you can enroll in a qualified health plan either through the federal Marketplace or a private insurer like Priority Health.
How long is the open enrollment period? When does it start?
For 2023 plans, the open enrollment period runs from Nov. 1, 2022 through Jan. 15, 2023. During this time, you're free to enroll in an individual or family health plan.
How does the open enrollment period work?
During OEP, you can enroll yourself and/or your family in a health plan for the following year. You can purchase a plan from a trusted health plan company or through the Marketplace. Be aware that not all insurers' plans are available on the Marketplace, as individual insurers may offer more choices if you shop with them directly. 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 gives you the opportunity to enroll during a special enrollment period (SEP). Otherwise, you'll need to wait until the next OEP and pay a penalty when you file your federal tax return.
Can I buy a health plan at any time?
You can only buy a health plan during open enrollment or special enrollment. Special enrollment is the exception to open enrollment. If you've experienced a qualifying life event you may be eligible for a special enrollment period.
Qualifying life events include: Loss of essential coverage, Loss of COBRA benefits, Marriage, Birth, Permanent relocation, Divorce, Adoption, Death of previous policy holder, Named legal guardian, New foster child, Change in citizenship, Newly eligible for government assistance
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.
5. Choose the plan that's right for you
Save and send plans
See all Priority Health plans available to you by providing a bit of information about yourself and where you live. You can star all the plans you would like to save or email them to yourself for when you are ready to enroll.
Speak with an enrollment specialist
Have questions or need some guidance? We're happy to help you pick an Individual & family health plan.
Call us at 833.709.2965 and you'll speak with a local customer service representative.
Or you can request a call and one of our enrollment specialists will contact you when it's most convenient.
Frequently asked questions (FAQs)
Are there Individual health plans for students?
Our specialists can help you with all the options available to college students. We understand that life as a student is busy!
Call us at 833.709.2965 and we'll help you pick a plan that fits your needs.
Can I change my Individual health plan at any time?
You choose your health plan for in the fall during open enrollment period (OEP). However, you can still change health plans outside OEP only if you qualify for a special enrollment period 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.
For 2023 plans, the open enrollment period occurs Nov. 1, 2022 through Jan. 15, 2023.