How to Choose the Best Individual Health Insurance Plans for Your Needs?
Navigating your private health insurance options can be confusing. If you have recently lost your job, or if you’ve taken a job that does not offer healthcare benefits, or if you’re self-employed and looking for an affordable healthcare plan, it can be a struggle to understand which option is best for you.
Fortunately, if you’re not eligible for insurance through an employer, you can still get great benefits. To help you understand the best individual health insurance plans for your needs and budget, we have ranked a couple of the most popular options below.
Our goal is to help make the confusing world of healthcare insurance a little more manageable and help you get the insurance plan you need.
What to know before you buy a plan
When purchasing your health insurance plan, things are a little more complicated than getting health insurance through an employer.
When you get benefits through your employer, you simply select a company plan and the payment for the plan automatically comes out of your paycheck each month.
If you recently turned 26, or recently became unemployed, or started a business or retired, you will need to purchase individual coverage.
A good place to look for health insurance is through the Health Insurance Marketplace that was created by the Affordable Care Act (ACA). If you recently retired, you may also be eligible to enroll in Medicare or Medigap.
How to buy individual health insurance
If you are not eligible for group health insurance through an employer, you will need to purchase individual health insurance. The best individual health insurance plan will vary depending on your needs.
You have two main options for buying an individual healthcare plan. You can buy either through private insurance companies or through the Health Insurance Marketplace.
Is buying individual health insurance a necessity?
If you are uninsured, you should try to enroll in an individual health insurance plan as soon as you are able. If you find yourself facing an accident or injury, you can end up in big trouble if you don’t have health insurance.
Even a minor injury or illness can be financially detrimental if you do not have insurance, and since it’s impossible to predict when you will need it, it is best to always have insurance.
Although health insurance can be costly, if you purchase your insurance plan through the Health Insurance Marketplace, you may be eligible for a reduced-cost plan.
The Health Insurance Marketplace offers plans at the state and federal level and can help you get the coverage you need to ensure an illness or injury doesn’t set you back financially.
Types of Individual Health Insurance Plans
Individual Health Insurance – types of individual insurance plans
You have several options for individual insurance plans. They include:
HMO: Health maintenance organization (HMO)
HMO plans are typically the most affordable individual plans, although they also usually have a smaller network of doctors and health providers, and no option to go out of network. You also will need to see your primary care doctor and get a referral to see a specialist.
When you get an HMO plan, you are enrolled in the healthcare provider network of an HMO, which is a company that allows its subscribers to access their network. When you enroll, you will usually have to have a monthly or annual fee for your coverage.
PPO: Preferred provider organization (PPO)
PPO plans give you access to in-network and out-of-network doctors, but the rates for out-of-network doctors are more expensive.
Under this plan, you do not need to choose a primary care doctor, and therefore you typically do not need a referral to see a specialist. PPO is a more flexible plan than HMO and may be preferable if you have specific doctors that you would like to see.
EPO: Exclusive provider organization (EPO)
EPO plans, like HMO plans, only offer benefits in-network, leaving you 100% responsible if you see an out-of-network doctor. Sometimes, exceptions can be made for emergency care, however.
On an EPO plan, you may be required to choose a primary care doctor, however, do not require a referral from your primary care doctor to see a specialist.
POS: Point of Service (POS)
POS plans include features from HMO and PPO. A POS plan lets you see any doctor in your network (including specialists) without a referral.
However, if you want to see a doctor outside of your network, you will need a referral. However, if you want to see an out-of-network doctor, you will be assessed for it, and it may be determined that you will be 100% responsible for the costs.
| Features | HMO | POS | PPO | EPO |
|---|---|---|---|---|
| Low deductible | Yes | Yes | Most plans | No |
| Low premium | Yes | Yes | No | Yes |
| Need referral to see specialist? | Yes | Yes | No | Some plans |
| Claim forms | No | If out of network | If out of network | No |
| Out-of-network coverage | No | Yes | Yes | No |
How Much do Individual Insurance Plans Cost?
The cost of an individual health insurance plan varies according to the benefits you choose. Research from the Kaiser Family Foundation found that the average cost of an individual healthcare plan was $440 per month, which is lower than the cost of many employer-sponsored plans.
You may be eligible for a reduced-cost plan as well, depending on a variety of factors.
The Cost-Sharing Reduction subsidy and Advanced Premium Tax Credits provide lower costs for premiums, deductibles, and copays, so you should check if you are eligible before purchasing an individual health insurance plan.
Where to Buy an Individual Insurance Plan
When purchasing an individual insurance plan, you have a couple of options. In 2014, the Affordable Care Act (ACA) created the Health Insurance Marketplace, which is a government-run marketplace that allows people to enroll in healthcare plans during the open enrollment period. It typically runs from November 1 to December 15 each year. To find out more about the options available in your state, you can visit the Health Insurance Marketplace website.
Another option is to buy health insurance directly from a private health insurance company. This can be a better option for people who do not want to wait until the open enrollment period and need health insurance right away.
However, it is important to note that the price you see on the website of a private insurance company, is not necessarily the price you will pay. When you apply and submit your medical history, the company will give you a quote for your actual price, which can vary depending on your health and history.
5 Best Private Health Insurance Companies
Best Individual Health Insurance Plans – Choosing the best health insurance company for you
If you decide to go with a private health insurance company, you have a lot of options. However, some options may be better or worse for you depending on your needs and circumstances.
Overall Best: UnitedHealthcare
UnitedHealthcare is a leading provider of private health insurance. They have one of the largest networks in the country and offer a wide and versatile array of options.
With plans for everyone from students to retirees, UnitedHealthcare has something that works for just about everyone. They also have an excellent online health portal, that lets you schedule appointments, get virtual consultations, see your status, manage your claims, and more.
Most Affordable: Kaiser Permanente
Kaiser Permanente offers some of the most affordable plans available. Their HMO plans are excellent options for anyone struggling to afford healthcare.
Most Kaiser Permanente plans require you to stay within the network, but if you live within a Kaiser Permanente service area, it can be the best option for getting quality healthcare at an affordable price.
Largest Network: Blue Cross Blue Shield
The Blue Cross Blue Shield (BCBS) Association provides health insurance to over 100 million Americans, and offers insurance plans in over 190 other countries, making it one of the largest health insurance providers in the world.
BCBS’s HMO plans provide excellent savings but limit doctor choices to inside the HMO. However, with BCBS’s wide network, this is less of a problem than it is with many other insurance providers.
The PPO plans offer great flexibility with one of the largest numbers of in-network doctors of any plan.
Best for Preventive Care: Molina Healthcare
Insuring more than 3 million people across the US, Molina Healthcare has a wide network that comes with excellent preventative care benefits, including coverage for adult and pediatric immunizations; adult, child, and adolescent preventive services; prenatal and postnatal care; hospital visits; x-rays; prescription drugs; and more.
Best for Telehealth Care: Cigna
These days, with the COVID-19 pandemic, getting remote healthcare is more important than ever. Cigna offers excellent telehealthcare options that let you connect with your primary care doctor or a specialist remotely, over the phone or via a video call.
Cigna also offers great benefits like pharmacy home delivery and a health information helpline, as well as a wealth of information available on their website, so you can get your healthcare from the comfort of your home.
