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Individual

Federal Marketplace

The Federal Marketplace is major medical insurance available to individuals and small business (through SHOP). Individuals are allowed to enroll in Marketplace coverage freely during the Annual Enrollment period that occurs during the end of each calendar year. Outside of this time period, individuals must have a Special Enrollment Period to elect coverage. 

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Examples of life events that trigger a special enrollment period include:

  • Marriage

  • Divorce

  • Had a baby, adoption, or a child placed in foster care

  • Death

  • Changes is residence (moving outside of a current service area)

  • Loss of other employer-sponsored health coverage

  • Losing eligibility in federal or state health programs (Tricare, Medicaid, CHIP)

  • Marketplace premiums are contingent on individual/family household income and size.  Individuals/Families that fall in between 138%-400% of the Federal Poverty Level may be eligible for a financial subsidy to help pay insurance premiums.  Additionally, individuals may qualify for cost sharing reductions if their income is below 250% of the federal poverty level and they select a Silver coverage plan. 

  • Individuals outside of the 400% Federal Poverty Level will pay the entire monthly premium.    

Independent Business Owner Insurance

Individuals outside of the 400% Federal Poverty Level will pay the entire monthly Marketplace premium which typically comes with a higher price tag.  A great alternative to this is establishing commercial insurance as an Independent Business Owner.   Sometimes termed as the “Sole Proprietor Program”, business owners that can produce the prior tax year’s Schedule C, W-2, or K-1 can “piggyback” off of the local commercial/group platform and see premium savings of up to 30% and access plans with lower deductibles, copays, coinsurance, and out-of-pocket maximums. 

Short Term Medical

Short Term Medical plans are widely used when individuals have a gap in major medical coverage or are relatively healthy and looking to pay lower premiums. 

 

Temporary health insurance can bridge the gap and are a perfect fit for the following life events:​

  • When you are between jobs

  • Waiting for a new health insurance to begin

  • Waiting to be eligible for Medicare

  • Waiting for Open Enrollment

 

Short term plans are not considered creditable coverage as defined by the Affordable Care Act.  If coverage ends, it does not qualify an individual to enroll in the Federal Marketplace coverage outside of the Annual Open Enrollment period. Most instill lifetime maximums and are not required to cover preventive services at 100%. 

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