Individuals
&
Families
Individuals
&
Families
If you don’t get insurance through an employer, Medicare, or Medicaid, there are still affordable and comprehensive health coverage options available to you and your family. Whether you're shopping on the ACA marketplace or considering private, non-ACA alternatives, there’s a solution that can meet your needs, budget, and health profile.
The Affordable Care Act (ACA) created a national marketplace where individuals and families can buy standardized health insurance through Healthcare.gov or a state-run exchange (available in 17 states and D.C.).
While ACA plans cover essential benefits and pre-existing conditions, they can be costly — especially if you don’t qualify for subsidies, which are only available to some based on income. Without financial help, premiums and deductibles are often high, and coverage may not begin until you’ve spent thousands out of pocket. More comprehensive coverage typically requires a higher-tier plan at a higher price.
Bronze: $381–$488/month
Silver: $486–$621/month
Gold: $507–$676/month
Platinum: ~$913/month
Guaranteed coverage — No one is denied for pre-existing conditions
Comprehensive benefits — Includes 10 essential services like hospitalization, prescriptions, maternity, mental health, and preventive care
No lifetime or annual limits
Subsidies available — Enrollees may qualify for premium tax credits, 70% pay $10 or less/month after subsidies
Cost-sharing reductions — Lower deductibles and out-of-pocket costs for low- to moderate-income individuals
If you're healthy and don’t qualify for ACA subsidies, private, non-ACA plans may offer significantly stronger benefits at a much lower cost. These plans are typically more affordable because they’re medically underwritten — meaning they're designed for individuals with low health risks. While they don’t offer government subsidies, they often provide better coverage, broader networks, and lower monthly premiums compared to unsubsidized ACA plans.
Full-featured health insurance, typically PPO-style
Lower premiums for healthy individuals
Often include nationwide provider networks
Requires health screening; can deny coverage or charge more based on health history
Offers strong benefits, often with lower deductibles than ACA plans
Temporary coverage lasting 30 days up to 364 days (varies by state)
Intended for gaps between major coverage (job change, missed open enrollment, etc.)
Covers unexpected medical events
Limited benefits: usually excludes maternity, pre-existing conditions, mental health, and prescriptions
Pays set cash amounts per medical service (e.g., $75 per doctor visit, $1,000 per hospital day)
No deductibles; you get paid regardless of your provider’s billed charges
Best used to supplement other plans or as a budget-friendly option for low users of care
Does not meet minimum coverage standards under the ACA
Offers cash payouts for specific conditions or services (e.g., hospital stays, surgeries, cancer, accidents)
Often includes bundled extras like dental, vision, or telemedicine
Does not offer comprehensive major medical coverage, but helps cover unexpected out-of-pocket costs
Designed for emergency-only coverage
High deductible, low monthly premium
Intended to protect against financial ruin from serious medical events
May not meet ACA essential coverage standards
Non-insurance, faith-based programs where members share each other’s medical bills
Lower monthly costs
No legal guarantee that claims will be paid
Typically excludes coverage for pre-existing conditions, prescriptions, mental health, or services that don’t align with the organization’s values
Monthly subscription to a primary care provider or clinic
Covers unlimited office visits, basic labs, and sometimes urgent care
Does not cover hospitalization, specialists, or major medical services
Often used in combination with indemnity or catastrophic plans
Not insurance, but provides discounted rates on doctor visits, prescriptions, lab work, imaging, and more
Typically includes unlimited 24/7 virtual care access
Useful for people who want low-cost access to basic care but do not need full insurance
May be bundled with dental, vision, or lifestyle benefits
⚠️ Important: Non-ACA plans don’t qualify for subsidies and may deny coverage based on medical history.
💡 Expert Tip: Many non-ACA plans can be combined (e.g., short-term + indemnity + telemedicine) to create a custom package that balances affordability, risk protection, and everyday access to care.
ACA Open Enrollment: Nov 1 – Jan 15 (some states extend beyond Jan 15)
ACA Special Enrollment Period (SEP): Available year-round if you experience a qualifying life event, such as:
Loss of job-based insurance
Marriage, divorce, or birth of a child
Moving to a new state
Loss of Medicaid or CHIP
Becoming a U.S. citizen
⚠️ Important: You must have had previous ACA coverage to qualify.
Private/non-ACA plan Enrollment: Most plans are available year-round, especially if medically underwritten or short-term.
Before choosing, consider the following:
Your income – Do you qualify for ACA subsidies?
Your health – Do you have pre-existing conditions or take regular prescriptions?
Your preferred doctors and hospitals – Are they in-network?
Your risk tolerance – Can you handle a higher deductible in exchange for lower premiums?
Flexibility needs – PPOs offer broader access but typically cost more; HMOs are more affordable but have limited networks.
Don't risk being uninsured — or overpaying for coverage that doesn’t work for you. Call JSR Health Consultants today for a free, personalized consultation.
Let’s find your best plan, together.
We’d love to learn more about you and help guide you through your health insurance options. Whether you're just starting your search or ready to enroll, we're here to build a relationship based on trust, clarity, and expert guidance.
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