Individual Health Insurance Programs & Coverages

The Affordable Care Act (or health care reform law) is changing how individuals will obtain health insurance and it is called the Health Insurance Marketplace (AKA exchanges). The enrollment period will begin November 1 through December 15 each year.

Individuals can choose from multiple insurance companies on the marketplace. Each plan must offer “essential health benefits” which include coverage for emergency room care, hospital stays, maternity and newborn care, prescription drugs and preventive care. Things like co-payments, coinsurance and deductibles will still be part of most plans.

There will be three levels of coverage: gold, silver and bronze. Each insurer will design the benefits each plan has within these levels and may or may not offer every category. However, each plan must meet certain rules, like covering “essential health benefits.” People will choose a level of coverage based on their budgets and health care needs. Coverage levels impact how much their premium costs each month and how much they pay for things like hospital visits or prescription drugs. Provider networks will also vary.