How to buy an individual health insurance plan

How do you get individual health insurance?

To get individual health insurance, start by deciding whether an ACA Marketplace plan or a plan purchased directly from an insurer fits your needs. ACA Marketplace plans provide comprehensive coverage and cannot deny you coverage or charge you more because of a pre-existing condition. You also could qualify for financial help based on your income. 

Healthcare.gov has comparison tools, cost calculators and educational resources to help you select the right plan for you and your family. The website can also help you estimate any premium subsidies you may be eligible for. Healthcare.gov, as well as the state websites, have representatives available to help.

If you live in one of the 17 states and the District of Columbia with its own exchange, you will use the state website to enroll. Those states include:

• California
• Colorado
• Connecticut
• District of Columbia
• Idaho
• Kentucky
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Jersey
• New Mexico
• New York
• Pennsylvania
• Rhode Island
• Vermont
• Washington

For any other state, use the federal government’s Healthcare.gov health insurance exchange to enroll.

You can find more individual and family options by shopping directly through health insurance companies offering plans outside the exchanges.

How much does it cost to buy health insurance on your own?

The average monthly Marketplace premium in 2026 ranges from $456 for the lowest-cost Bronze plan to $615 for the lowest-cost Gold plan, according to the Kaiser Family Foundation (KFF). Plans with lower premiums generally have higher deductibles and other out-of-pocket costs, while plans with higher premiums pay a larger share of covered medical expenses. 

When deciding on the level, consider the medical services you used over the past year and what you expect next year. Healthcare.gov and the individual state websites have calculators to help you.

According to the Kaiser Family Foundation (KFF) [2026], the average premiums for the bronze, silver, and gold plans are:

What’s the cheapest health insurance?

Bronze plans have the lowest premiums among the standard ACA Marketplace metal tiers, but they also have the highest out-of-pocket costs. Financial assistance can reduce premiums for eligible shoppers. Healthcare.gov and state websites have calculators to help you estimate your subsidies and total cost.

Non-ACA-compliant plans may be less expensive, but the benefits are limited. Be sure to compare them to the ACA plans before deciding.

There are also very cheap plans called catastrophic plans. These have very specific eligibility requirements and low monthly costs but high deductibles.

When can you buy an individual health plan?

You can purchase or change individual health insurance during the open enrollment period. Open enrollment for most states is from Nov. 1 to Jan. 15. States with their own exchanges usually offer expanded open enrollment.

States with slightly different open enrollment periods include California, the District of Columbia, Idaho, Maryland, New Jersey, New York, and Rhode Island.

The only other time you can get individual health insurance coverage is if you have a qualifying event that launches a special enrollment period. These events may have caused you to lose your health insurance coverage. The special enrollment period lasts 60 days.

Special enrollment qualifying events include:

• Getting married
• Having a baby, adopting a child or placing a child for adoption or foster care
• Moving
• Becoming a U.S. citizen
• Leaving incarceration
• Losing other health coverage due in the past 60 days to job loss, divorce, COBRA expiration or aging off a parent’s plan
• Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
• Change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies
• Gaining status as a member of an Indian tribe

The ACA marketplace’s open enrollment is usually from Nov. 1 to Jan. 15 in most states, but some states have different periods.

People with income up to 150% of federal poverty level ($19,320 for a single person, $32,940 for a family of three) are eligible for a monthly special enrollment period. The Centers for Medicare and Medicaid Services estimates that about one-third of marketplace plan members qualify.

Do you need individual health insurance?

Individual health insurance is an option for people who do not have coverage through an employer or another source such as Medicare, Medicaid or a government program. You can buy an individual plan through the ACA Marketplace or purchase certain plans directly from an insurer or broker. 

You can buy individual health insurance through the ACA marketplace and non-ACA policies through brokers and directly from insurance companies.

What do individual health plans cover?

ACA Marketplace individual health plans provide comprehensive coverage and cover people regardless of their health history. Marketplace plans cover pre-existing conditions, including pregnancy, diabetes and cancer. They also have an annual out-of-pocket maximum and cannot place lifetime or annual dollar limits on essential health benefits. 

In addition, all ACA marketplace individual health plans must cover a standard set of 10 essential health benefits:

• Outpatient care, including doctor’s visits
• Emergency room visits
• Hospitalizations
• Pregnancy and maternity care
• Mental health and substance abuse treatment
• Prescription drugs
• Services and devices for recovery after an injury, due to a disability or a chronic condition
• Lab tests
• Preventive services, including health screenings, immunizations, and birth control. You pay nothing out of pocket for preventive care when you see healthcare providers in your plan’s network.
• Pediatric services, including dental and vision care for kids.

Plans that are not ACA-compliant are available directly from insurance companies. They’re generally less expensive, have limited benefits, and can decline to offer coverage based on your health history.

How to choose an individual health plan

Choose an individual health plan by comparing the premium, deductible, copayments, coinsurance, provider network, and covered services. ACA Marketplace plans are divided into four metal tiers — Bronze, Silver, Gold and Platinum — based on the share of medical costs the plan pays compared with what you pay. 

The percentages are estimates based on how much medical care an average person would use in a year. Platinum plans, which pay 90% of healthcare costs, are more expensive than Silver plans that pay 70% of healthcare costs. Not all providers accept every plan.

Individual health insurance subsidies

People who buy an individual health plan through the ACA exchanges may be eligible for subsidies that reduce the cost of premiums. The ACA allows tax credits and subsidies. Only people with household income between 100% and 400% of the federal poverty level are eligible for subsidies.

The expiration of the enhanced premium tax credits at the end of 2025 reduced the number of people eligible for subsidies. The American Rescue Plan, signed into law by President Biden in 2022, lifted the income cap on subsidies and increased their amounts. When it expired, fewer people were eligible and subsidies reverted to their pre-2022 level.

Reminder: People with an individual health plan outside of the exchanges aren’t eligible for subsidies.

Other ways to get health insurance

Individual health insurance is one way to get coverage, but other options include short-term health plans, Medicaid and catastrophic health plans. The right option depends on your eligibility, budget and the level of coverage you need.

Other options include:

• Short-term plans. These plans don’t offer the same benefits as a normal health insurance plan. Insurers aren’t required to provide comprehensive benefits. Most short-term health plans don’t cover maternity, prescription drugs and mental health. Instead, you pay for that care yourself. Short-term plans aren't meant as a long-term health insurance solution. You can only have them for one year and can request two extensions. These plans are low-cost, but they have limited benefits. Also, a handful of states don’t allow short-term plans, while others restrict them to shorter time frames.
• Medicaid. Medicaid is available to people who qualify. Thirty-nine states expanded Medicaid, which allows people who make up to 138% of the federal poverty level eligible for Medicaid. That level is $17,609 for a single person, $23,791 for a two-person family and $36,156 for a family of four. Medicaid plan costs depend on your income, but you’ll pay less for Medicaid than an employer or individual plan if you qualify. Medicaid offers comprehensive health insurance despite the lower costs.
• Catastrophic health plans. If you’re under 30 or meet income requirements, you could qualify for a catastrophic health plan. These plans offer lower premiums but come with much higher deductibles and out-of-pocket costs than standard health insurance plans. The idea behind catastrophic plans is to give people coverage to prevent financial ruin if they have emergency health care needs. Unlike short-term health plans, which don’t cover many services, catastrophic plans offer the same level of coverage as standard ACA plans.

What to consider when buying individual health insurance

When buying individual health insurance, compare the plan's total cost, provider network, covered services and flexibility. A low monthly premium does not always mean a lower overall cost, especially if the plan has a high deductible or limited provider network. 

Here are some questions to consider:

How much flexibility do you want in your plan?

When choosing an individual health plan, you want to consider the type of benefit design. Health maintenance organization (HMO) plans are the most common plan design in the individual market.

HMOs include restricted provider networks. HMO members can only see doctors and get care from facilities in those networks. Also, you need a primary care provider referral to see a specialist.

Exclusive provider organization (EPO) plans don’t allow you to get care outside of the network, but you also don’t need a referral to see a specialist.

Preferred provider organization (PPO) plans are more flexible. You can see doctors both in your network and outside the network. You don’t have to get referrals to see specialists. However, PPOs have much higher premiums than HMOs, so you pay more for that flexibility.

Find out the differences between HMOs, PPOs, and other types of health plans.

Are your providers in network?

Check the plan's provider directory before enrolling to ensure your doctors, hospitals, and specialists are in-network. This is especially important with an HMO because this type of plan does not cover out-of-network care. 

If you get a PPO, you’ll likely be able to get out-of-network care, but it can come at a higher price tag.

What does private health insurance cover?

Compare the plan's covered services, prescription drug list, deductibles, and out-of-pocket costs before enrolling. Check whether your medications are covered and whether the plan includes the doctors and services you need. Plans can differ significantly in their coverage and cost-sharing. 

What are the insurance companies' reputations?

You’ll also want to check out the company’s consumer reviews and financial standing. You can review Insure.com’s Best Health Insurance Companies for customer satisfaction ratings and company A.M. Best Financial Strength Ratings.

Making a smart individual health insurance choice requires time and effort, but the homework you do now will pay off later when you and your family need care.

Sources:

• KFF. "Average monthly marketplace premiums by metal tier." Accessed October 2026.