Individual Health Plans
Here at PDX Insurance & Associates Insurance Agency, we prioritize finding you the best individual health insurance coverage.
Health Insurance Under 65
Health insurance is a critical component of financial and physical well-being. For individuals under 65 who don’t have access to employer-sponsored health insurance, the Affordable Care Act (ACA) Marketplace offers a range of options. We'll outline the essential details of ACA Marketplace plans, deadlines, and resources to help you make an informed decision. We're also here to help, so please reach out to discuss your specific health insurance needs to ensure you have the right coverage.
The ACA Marketplace, established under the Affordable Care Act, is a platform where individuals and families can shop for and enroll in health insurance plans. These plans are regulated to ensure they meet specific standards, such as covering essential health benefits and providing protection for people with pre-existing conditions.
Key Features of ACA Plans
When exploring Individual ACA health plans, you’ll find they offer:
Essential Health Benefits: All plans must cover services like preventive care, maternity care, mental health services, and prescription drugs.
Pre-existing Condition Protections: Insurers cannot deny coverage or charge higher premiums based on your health history.
Subsidies & Tax Credits: Many individuals and families qualify for financial assistance to lower their premiums and out-of-pocket costs.
Metal Tiers: Plans are categorized into four metal levels based on how costs are shared between you and the insurer:
Bronze: Lowest premiums, highest out-of-pocket costs.
Silver: Moderate premiums and cost-sharing; eligible for cost-sharing reductions, if you qualify.
Gold: Higher premiums, lower out-of-pocket costs.
Platinum: Highest premiums, lowest out-of-pocket costs.
ACA Marketplace Plan Cost
Understanding the different terms you’ll run across with individual health insurance plans is important to determining costs. Here are the top three terms to know:
Copayments & Coinsurance: Your share of the cost of medical services after meeting your deductible
Deductibles: The amount you pay out of pocket before insurance starts covering expenses
Premiums: The amount you pay each month for coverage
Additionally, there are financial assistance programs in place that can lessen the burden of healthcare costs for individuals. Many people qualify for subsidies to reduce premiums and other costs. Assistance is based on your household income and size:
Premium Tax Credits: Available to individuals and families with incomes between 100% and 400% of the federal poverty level (FPL)
Cost-Sharing Reductions: Lower out-of-pocket costs for Silver plan enrollees with incomes between 100% and 250% of the FPL
Speak with someone from our team to estimate your eligibility for subsidies.
Note: If your income falls below certain thresholds, you may qualify for Medicaid or the Children’s Health Insurance Program (CHIP). Both of these programs provide free or low-cost coverage. Eligibility varies by state.
Who Can Enroll in ACA Plans?
Anyone can purchase a plan through the Marketplace, but it’s especially beneficial for:
Individuals who don’t have employer-sponsored insurance
Self-employed workers
Part-time employees
Individuals whose income qualifies them for Medicaid expansion
(in participating states)
Important ACA Dates & Deadlines
Open Enrollment Period (OEP)
The Open Enrollment Period typically runs from November 1st to December 15th each year. However, exact dates may vary by state, so it’s crucial to check your state’s Marketplace or connect with a licensed health insurance agent to confirm your deadlines.
During OEP, you can:
Enroll in a new health plan
Renew or change your existing plan
Special Enrollment Period (SEP)
If you experience a qualifying life event, you may be eligible for a Special Enrollment Period. Common qualifying events include:
Losing other health coverage
Getting married or divorced
Having a baby or adopting a child
Moving to a new coverage area
The SEP generally lasts 60 days from the date of the qualifying event.
Choosing the Insurance Plan
Before you choose a plan for you and your family, you must first assess your needs. Consider the following factors:
Health status
Budget
Preferred providers
Prescriptions
Then, be ready for enrollment season.
Follow these steps to make your process even smoother:
Gather information: Have the following ready:
Social Security numbers for all household members
Employer and income details
Immigration documents (if applicable)
Apply early: Avoid last-minute stress by enrolling well before the deadline
Review details: Double-check your application for accuracy to avoid processing delays and resubmissions
Set up payments: Ensure your payment methods are set up correctly so your coverage begins on time