Individual Plans
Need individual health insurnace coverage? We can help you through every step of the process.
Individual Plan Basics
An individual health insurance policy is your own personal policy that is not tied to an employers group plan. Premiums are based on your age, zip code, and smoker status. As of 1/01/2014, the Affordable Care Act (ACA) law prohibits insurance companies from discriminating against individuals with preexisting conditions and coverage will be guaranteed. Once you are approved, the insurance company cannot cancel your coverage for excessive claims.
Enrollment in an Individual plan
A new limitation added by the ACA is that you can only sign up for coverage during the open enrollment period. This period will run from November 15th to January 15th. You can sign up for insurance outside of the open enrollment period only if you qualify for a special enrollment.
Some of the reasons for Special Enrollment include:
- Loss of minimum essential coverage, such as the loss of a job or through a divorce.
- Change in family size due to factors such as marriage, birth, adoption, divorce, or death.
- Change to citizenship or immigration status.
- Release from incarceration.
- Current plan substantially violated a material provision of its contract.
- Newly eligible or ineligible for premium tax credits or cost-sharing assistance.
- Newly pregnant or disabled (may result in eligibility for Medicaid and loss of premium tax credit
- eligibility).
- Permanent move to a new ZIP code and have access to new health plans.
- Member of an American Indian tribe (American Indians can enroll in a plan or change plans one time each month).
- Demonstrated other extenuating circumstances that qualify for special enrollment.
Choosing the Right Individual Health Insurance Plan
When selecting an individual health insurance plan, it’s essential to consider coverage options, provider networks, and costs. Two of the top insurers in Illinois, Blue Cross & Blue Shield of Illinois (BCBSIL) and United Healthcare (UHC), offer a range of plans designed for individuals and families.
Blue Cross & Blue Shield of Illinois (BCBSIL)
- Available statewide in all Illinois counties
- Offers both Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans
- Provides various deductible and out-of-pocket options, including Health Savings Account (HSA)-compatible plans
- Consistently offers the most competitive pricing for individual plans compared to UHC
United Healthcare (UHC) & Other Insurers
- Available in select counties across Illinois
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UHC offers additional coverage options to enhance your health plan, including:
- Dental Insurance – Covers routine cleanings, exams, and major dental procedures
- Vision Insurance – Helps with eye exams, glasses, and contact lenses
- Accident Plans – Covers medical expenses from unexpected injuries
- Hospital Indemnity Plans – Provides financial support for hospital stays
- Cancer Plans – Offers coverage for cancer-related treatments and expenses
- Provides a range of individual and family plans in areas where coverage is available
Both insurers bring financial strength, stability, and expertise to their plans, ensuring reliable coverage options.
Need help finding the best plan for your needs? Contact us today for expert guidance.
Should You Stay on Your Employer’s Health Plan or Choose Individual Coverage?
Many employers are reducing their contributions toward employee health coverage or eliminating group plans altogether. If your employer covers more than 50% of your premium, staying on your group plan is likely the best option. However, it’s still important to compare your costs and coverage with individual health insurance options to ensure you’re getting the best value.
Key Considerations:
- Pre-Tax vs. Post-Tax Contributions: Most employer-sponsored health plans allow employees to pay their portion of premiums with pre-tax dollars, while individual health plans are typically paid with post-tax income.
- Cost Comparison: Group health plan rates can sometimes be higher than those available for individual plans, especially if your employer contributes less toward your premium.
- Who Should Consider an Individual Health Plan?
- Self-Employed or Unemployed individuals
- Students needing their own coverage
- Non-Smokers, who often receive lower individual plan rates
- Anyone between ages 19 and 64 looking for flexible coverage options
Save More with Supplemental Coverage
If you’re young, active, and participate in sports or outdoor activities, you may want to pair a higher-deductible health plan with an accident policy. This strategy can help lower your overall premium while ensuring you’re covered for unexpected injuries.
Not sure which option is right for you? Contact us today for a personalized comparison.
