If you don’t have employer-sponsored healthcare, you can buy Individual and Family coverage from the Affordable Care Act health exchange or directly from a private health insurer

You can purchase or make changes to ACA individual health insurance during the open enrollment period. Open enrollment for most states is from Nov. 1 to Jan. 15. States with their own exchanges usually offer expanded open enrollment.

Some state regulated private health care companies allow you to enroll at any time of the year as long as you are able to qualify for their health coverage options.

The only other time you can get individual health insurance coverage is if you have a qualifying event that launches a special enrollment period. These events may have caused you to lose your health insurance coverage. The special enrollment sign up period lasts 60 days.

• Getting married

• Having a baby, adopting a child or placing a child for adoption or foster care

• Moving

• Becoming a U.S. citizen

• Leaving incarceration

• Losing other health coverage due in the past 60 days to job loss, divorce, COBRA expiration or aging off a parent’s plan

• Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)

• Change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies

• Gaining status as a member of an Indian tribe

The ACA marketplace’s open enrollment is usually from Nov. 1 to Jan. 15 in most states, but starting in 2022, low-income Americans have had more chances to get a marketplace plan.

• People with income up to 150% of federal poverty level ($19,320 for a single person, $32,940 for a family of three) will be eligible for a special enrollment period each month. The Centers for Medicare and Medicaid Services estimates that about one-third of marketplace plan members will qualify.

ACA marketplace Individual health insurance plans offer comprehensive coverage. ACA marketplace plans have to offer coverage to you regardless of your health history. You qualify for individual health insurance even if you’re pregnant, or have a long-term condition like diabetes or a serious illness, such as cancer. ACA marketplace health plans can’t cap the amount of benefits you receive and limit out-of-pocket costs you have to pay in a year.

In addition, all ACA marketplace individual health plans must cover a standard set of 10 essential health benefits:

• Outpatient care, including doctor’s visits

• Emergency room visits

• Hospitalizations

• Pregnancy and maternity care

• Mental health and substance abuse treatment

• Prescription drugs

• Services and devices for recovery after an injury or due to a disability or chronic condition

• Lab tests

• Preventive services, including health screenings, immunizations, and birth control. You pay nothing out of pocket for preventive care when you see health care providers in your plan’s network.

• Pediatric services, including dental and vision care for kids.

Some NON-ACA Plans offered through private companies are medically underwritten and will offer coverage strictly based off of applicant medical history. These plans tend to be much stronger and more affordable compared to ACA plans, but you have to medically qualify. 

There are also other plans that are not ACA compliant available directly from certain insurance companies that are generally less expensive, have limited benefits, and can decline to offer coverage based on your health history.

If you aren’t eligible for employer-sponsored health insurance, Medicare, Medicaid, veteran’s benefits or any other government program, you should buy individual health insurance.

You can buy individual health insurance through the ACA marketplace, as well as NON-ACA policies through brokers and directly with insurance companies.

When choosing an individual health plan, you want to consider the type of benefit design. Health maintenance organization (HMO) plans are the most common plan design in the individual market.

HMOs include restricted provider networks. HMO members can only see doctors and get care from facilities in those networks. Also, you need a primary care provider referral to see a specialist.

Exclusive provider organization (EPO) plans don’t allow you to get care outside of the network, but you also don’t need a referral to see a specialist.

Preferred provider organization (PPO) plans are more flexible. You can see doctors both in your network and outside the network. You don’t have to get referrals to see specialists. However, PPOs have much higher premiums than HMOs, so you pay more for that flexibility.

Check the health plan's network to make sure it has a good selection of hospitals, doctors and specialists. Look for your providers in the plan’s network.

This is especially true if you get an HMO. HMOs have a restricted network and won’t pay for the care you receive outside of the network.

If you get a PPO, you’ll likely be able to get out-of-network care, but it can come at a higher price tag.