Individual & Family Medical Insurance — Finding the Right Plan for Your Family
Health insurance is the most important financial protection your family can have. We help individuals and families compare ACA marketplace plans, off-exchange options, and subsidy eligibility to find the right fit.
How Individual Health Insurance Works
Individual and family plans are purchased directly through the ACA marketplace or off-exchange. Your options, costs, and subsidy eligibility all depend on your income, household size, and location.
ACA Marketplace Plans
Plans sold through Healthcare.gov or your state marketplace. The only plans eligible for premium tax credits based on your income. Metal tiers — Bronze, Silver, Gold, Platinum — determine your cost-sharing structure.
Premium Tax Credits
If your household income is between 100% and 400% of the federal poverty level, you may qualify for a premium tax credit that significantly reduces your monthly premium. Enhanced subsidies extend beyond 400% FPL.
Metal Tiers Explained
Bronze plans have the lowest premiums and highest out-of-pocket costs. Platinum plans reverse that. Silver plans offer cost-sharing reductions for eligible lower-income enrollees — often the best value when you qualify.
Open Enrollment & SEPs
ACA plans can only be purchased during Open Enrollment or a Special Enrollment Period triggered by a qualifying life event — loss of coverage, marriage, birth, or change in income.
Network Types
HMO, PPO, EPO, and POS plans each have different network and referral rules. We help you understand which type makes sense based on your doctors and how you prefer to access care.
1,000s of individual medical clients
We help clients navigate the ACA marketplace, compare off-exchange plans, and maximize their subsidy eligibility across the country.
What affects your premium
- Age (older enrollees pay up to 3x younger)
- Household size and income
- Geographic location (state and county)
- Tobacco use (surcharge in most states)
- Metal tier and plan type chosen
Plan Tiers & Options
ACA plans are grouped into metal tiers that determine how costs are split between you and your insurer. The right tier depends on how often you use care and whether you qualify for subsidies or cost-sharing reductions.
Bronze Plans
Lowest monthly premium, highest deductible. Best for healthy individuals who rarely use care and want catastrophic protection only.
- Lowest premium option
- High deductible (typically $5,000+)
- Covers 60% of average costs
- HSA-eligible if HDHP-qualified
Silver Plans
Mid-range premiums. The only tier eligible for cost-sharing reductions (CSRs) that dramatically lower deductibles and copays for eligible enrollees.
- Covers 70% of average costs
- CSR eligible for qualifying incomes
- Best value for subsidy-eligible enrollees
- Most popular marketplace tier
Gold Plans
Higher premiums, lower out-of-pocket costs. Best for people who expect to use their insurance frequently.
- Covers 80% of average costs
- Lower out-of-pocket when care is used
- Predictable cost-sharing
- Good for ongoing prescriptions or conditions
Platinum Plans
Highest premiums, lowest cost-sharing. Best for people with significant ongoing medical needs who want maximum predictability.
- Covers 90% of average costs
- Lowest deductibles available
- Highest monthly premium
- Best for complex ongoing care
Off-Exchange Plans
Carriers sometimes offer plans outside the marketplace with different network or benefit designs. Not subsidy-eligible, but may offer advantages for those who do not qualify for tax credits.
- Not subsidy-eligible
- May offer wider networks
- Different plan designs
- Compare carefully vs. marketplace options
Catastrophic Plans
Available only to people under 30 or those with a hardship exemption. Very low premiums with very high deductibles.
- Must be under 30 or have exemption
- Very low premium
- Very high deductible ($9,000+)
- Three free primary care visits per year
Frequently Asked Questions
Answers to the questions we hear most often about individual and family health insurance, subsidies, and enrollment.
You can enroll during Open Enrollment (typically November 1 through January 15 in most states) or during a Special Enrollment Period triggered by a qualifying life event such as losing employer coverage, marriage, divorce, birth, adoption, or a change in income.
Premium tax credits are available to households with incomes between 100% and 400% of the Federal Poverty Level. Enhanced subsidies have extended eligibility above 400% FPL in recent years. We calculate your estimated subsidy based on your household size, income, and location.
The deductible is what you pay before insurance starts covering most services. The out-of-pocket maximum is the most you will pay in a year, after which insurance covers 100%. Understanding both numbers is essential when comparing plans.
It depends on the plan network. Before enrolling, verify that your preferred doctors and hospitals are in-network. Network adequacy varies significantly by carrier and geography.
If you miss Open Enrollment without a qualifying life event, you may be limited to short-term medical plans or other alternatives until the next enrollment period. We can help you understand your options and plan ahead.
Let's find the right health plan for your family.
We compare ACA marketplace plans, off-exchange options, and subsidy eligibility to find coverage that fits your health needs and your budget.