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Is Individual Health Insurance right for you?


For individuals who are not yet eligible for Medicare but are in need of health coverage, individual health plans 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 employer coverage and your Medicare eligibility. If you’re looking for coverage, RetireMed can help. 

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Individual Insurance Options

There are three types of individual coverage available in the United States.

  1. Marketplace Plans
  2. Short-Term Plans
  3. Medi-Share/Faith-Based Plans

Marketplace Plans

Made possible by the Affordable Care Act (ACA), Marketplace plans are offered by private health insurance companies. All Marketplace plans are network-based. Most use health maintenance organization (HMO) networks. They cover pre-existing conditions and have no lifetime coverage limits.

All Marketplace plans cover 10 essential benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalizations
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services (including dental and vision care)

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)

Tax credits are available for individuals on these plans, unless other “affordable” coverage is available through your or your spouse’s job. If you have job-based insurance, the amount you pay will depend on whether your employer’s coverage meets certain standards of affordability. Affordability is determined by the amount you would pay for self-only coverage, since this applies to individual insurance plans.

Your coverage is deemed affordable if your share of the monthly premiums (for the lowest-cost self-only coverage meeting the minimum value standard) is less than 9.78 percent of your household income.

If you have Medicare, you cannot switch to Marketplace insurance or use it to supplement your health or dental coverage.

Short-Term Plans

Short-term plans may be the right option for you if you need coverage for less than a year—for example, you or your spouse being laid off six months before your Medicare eligibility. Also offered by private insurance companies, short-term plans tend to be more affordable than Marketplace plans when you do not qualify for premium tax credits. But unlike Marketplace, short-term plans are medically underwritten and do not cover pre-existing conditions.

Lifetime limits on short-term plans range from $1 million to $2 million, as they are intended to be used in emergency situations, not for planned care. Coverage can generally start any day of the year (forgoing an open enrollment period), but short-term plans are not guaranteed renewable once they expire.

Medi-Share/Faith-Based Plans

Since Medi-Share plans (which are based on religious beliefs) do not meet the federal guidelines for the ACA, they are not eligible for tax credits. As such, they tend to be more expensive. Individuals on these plans pay into a pool from which claims are paid—depending on available funds and determined by the plan.

Medi-Share benefits vary, and common health care needs may be excluded from coverage or subject to a waiting period. We recommend reading the plan documents carefully before enrolling to understand how a plan will care for your medical needs.

Exploring Individual Health Plans with RetireMed

The health insurance landscape can be overwhelming, but that’s why we’re here. Our team of trusted advisors will work to find the right individual health plan for you, all at no cost. We’ll begin by assessing your individual needs and priorities before researching different plan options to find the right health insurance plan for you.

Contact us today and be on your way toward exploring your individual coverage options. Schedule a call or call 937.915.3563 to speak with an advisor.


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