Individual Plans Eligibility
Is Individual Health Insurance right for you?
Explore your options for health coverage before Medicare.
Learn if you’re eligible for an Individual Health Plan.
If you’re in need of health coverage but not yet eligible for Medicare, an individual health insurance plan may be the right option. Perhaps you’ve been furloughed recently, or your spouse has lost coverage, or you may be planning to retire before the age of 65 and won’t yet be eligible for Medicare.
Regardless of your situation, individual health insurance can give you the benefits you need to bridge the gap between your current or former coverage and Medicare. If you’re looking for coverage, RetireMed can help you determine which individual health plan is best for your circumstances.
Your Individual Health Insurance Options
Short-Term Plans
Short-term plans may be the right option for you if you need coverage for less than a year. These plans often help individuals bridge the gap until their Medicare eligibility. Offered by private insurance companies, short-term plans are intended to be used for unexpected and unanticipated medical needs, not for planned care. Unlike Marketplace plans, short-term plans are medically underwritten and do not cover pre-existing conditions. Coverage can generally start any day of the year, but short-term plans are not guaranteed renewable when they expire.
Marketplace Plans
Marketplace plans, commonly referred to as Affordable Care Act (ACA) plans, provide private health coverage for individuals or families without employer-sponsored coverage. A Marketplace plan may be the right option if you need coverage for more than one year before your Medicare eligibility and/or if you have pre-existing conditions. All Marketplace plans are network-based, and most use health maintenance organization (HMO) networks. They cover pre-existing conditions and have no lifetime coverage limits.
Open enrollment for Marketplace plans is Nov. 1 to Dec. 15 each year. You may also qualify for a special enrollment period in any of the following circumstances:
- Change in household size
- Change in residence or income
- Change in status (such as being denied Medicaid/CHIP, gaining lawful presence in the United States, or being released from incarceration)
- Loss of coverage within a 60-day window (not including a loss of coverage from a short-term plan or voluntary disenrollment from a COBRA plan before expiration)