Individual Health Insurance Options for Single Adults

Individual health insurance for one is a private insurance plan that pays medical expenses for a single adult or child.

In the US, these plans can be purchased direct from insurers or via the Health Insurance Marketplace. Choices vary from minimal to more comprehensive, with diverse networks, premiums and coverage.

For those who don’t secure insurance through their job, these plans provide straightforward access to necessary care.

Your Individual Health Insurance Options

Individual health insurance provides single adults a means to obtain a health insurance plan outside of an employer. Plans are offered in the federal Marketplace, through private insurers, or as alternatives, each with its own regulations and fees, affecting their suitability for your healthcare needs.

1. Marketplace Plans

Marketplace plans are sold on the Health Insurance Marketplace and are required to adhere to ACA guidelines. They cover essential health benefits, including hospital stays, doctor visits and preventive care such as annual exams and flu shots at no additional cost.

Based on your income, you may be eligible for subsidies to assist with your monthly premium and out-of-pocket expenses. For 2024, these plans can’t have an out-of-pocket limit higher than $9,450, but the actual limit varies by plan and company.

Marketplace plans include provider networks with specific doctors and hospitals, so make sure yours are covered before choosing a plan.

2. Short-Term Plans

Short-term health insurance is designed for gaps, not the long-term. You may purchase a policy for a few months or a year or so, but coverage is much more limited.

They infrequently have essential health benefits or preventive care, and pre-existing conditions might not be covered. These plans are simpler to get into, but you can be rejected for some medical problems.

They typically have lower monthly costs but can expose you to large bills when you require care. Short-term plans are perfect for those between jobs or waiting for other coverage to kick in.

3. Catastrophic Plans

Catastrophic plans are for adults under 30 or with a hardship exemption. The headline appeal is a reduced monthly premium, but you spend more out of pocket when you actually have to access care.

The deductible is supreme—usually equal to the annual limit permitted by law. Once you satisfy the deductible, the plan covers key care. Preventive care is still covered at no additional cost.

These plans work if you’re healthy and want to pay less per month, but provide less assistance with routine medical expenses.

4. Off-Exchange Plans

Off-exchange plans are purchased directly from insurers or brokers, not the Marketplace. They provide additional options, even plans that might not be offered on-exchange.

You don’t get subsidies for these, so you pay the full premium. Dig into the details—especially what’s covered, network size and out-of-pocket limits.

Few plans include dental, vision or life insurance.

5. Alternative Coverage

Others resort to health sharing ministries or indemnity plans. These aren’t insurance but assist with medical bills for a small group.

They can be cheaper, but might impose limits, exclude pre-existing conditions or not cover routine care. They’re appropriate for those who desire a lower-cost option and are comfortable with the risks.

Understand the True Cost

The true cost of individual health insurance extends well beyond the monthly premium. Many factors, including your location, age, and the specific health insurance plan you choose, influence what you pay. Understanding all the pieces—premiums, deductibles, copays, and out-of-pocket limits—offers a more transparent view into what your health coverage will actually cost.

Your Premium

Premiums are the fixed cost you pay each month to maintain your health insurance plan coverage. In the U.S., the average monthly premium for an individual health plan from the marketplace is $456, but this price can fluctuate. Someone in LA could pay more or less than the average, with rates typically higher in rural counties or areas with a single insurer—occasionally 10% or higher because of minimal competition.

Premiums aren’t just the monthly sticker price. They vary depending on your age, location, and tobacco usage. For instance, a 64-year-old can shell out roughly three times as much as a 21-year-old for the same health insurance policy. Over the past 10 years, premiums have increased 68%, with plans that used to be around $271 a month now closer to $456.

Subsidies do matter, for everyone from 90% of marketplace enrollees getting some premium assistance to 80% paying $10 a month or less. When exploring different types of health plans, it’s essential to compare plan details, as lower premiums can mean higher costs elsewhere.

Your Deductible

A deductible is the amount you pay before your health insurance plan kicks in. If your deductible is $2,000, you pay for the first $2,000 in care every year. High deductible plans typically have lower premiums, but your portion of expenses when you require care increases. Choosing a high-deductible health insurance policy could save you money each month, but prepare for larger costs if you have higher health usage.

Deductibles are key to compare, especially if you anticipate utilizing more or less care. Calculating your medical needs will help you strike the perfect balance. Go for a lower deductible if you have consistent doctor visits or take medications frequently, particularly when looking at family health coverage options.

An elevated one could be effective if you’re healthy and rarely see the doctor. Choosing the right deductible can save you thousands a year, especially when paired with the right metal tier.

Your Out-of-Pocket Maximum

Your out-of-pocket max is the absolute most you’ll spend in a year on covered services. Once you hit this limit, insurance pays 100% of costs for the remainder of the year. This is important for budgeting, as it limits your exposure, even if you require extensive care.

Some plans put this limit higher, others lower. Comparing these numbers across plans is clever, particularly if you desire security or anticipate expensive medical costs. Always know this number before you enroll. It’s a major component of your annual health expenses.

When Can You Enroll?

Knowing when you can enroll in a health insurance plan in the U.S. is crucial. There are only a few times a year to enroll in health plans, and if you miss them, your choices are limited. Certain life events will swing other doors wide open, but you’ll need to move quickly.

Open Enrollment

Open Enrollment is once a year, typically November 1 to January 15, but dates vary slightly by state. This window is your primary opportunity to purchase, switch or cancel a plan for coverage in the following year. If you miss this, then you’d have to wait until next year to get coverage unless you qualify for a Special Enrollment Period.

So while you’re at it, it’s savvy to review your existing plan against others and see what’s different—costs, benefits, networks. For instance, perhaps your doctor is no longer in-network or your prescription coverage changed. Here’s your opportunity to course correct.

Life changes, such as moving out of state or an increase or decrease in your income, could indicate you require a new plan. It’s smart to reserve time ahead of the deadline to review your options, collect required information, and stave off deadline anxiety. Many turn to online marketplaces or a broker to assist in comparing plans side by side.

Special Enrollment Period

Missed Open Enrollment? You might still be able to get a health insurance plan if you experience a triggering life event. This could be due to loss of other coverage, marriage or divorce, a new baby, a new ZIP code, or aging off a parent’s plan at 26. The rules are pretty strict, and not every change counts towards qualifying for short term health insurance plans.

The period for Special Enrollment is typically 60 days from the date of the event, allowing you to choose from various health plans. For instance, if you lose your job-based coverage on June 1, you have until July 30 to sign up. You’ll need to provide documentation of the event — a letter from your employer, marriage certificate, lease agreement, etc.

If you wait too long, you’ll have to wait for the next Open Enrollment, so acting quickly to secure the right health insurance plan counts.

Documentation and Preparation

You’ll need things like citizenship or legal presence, income information, social security numbers, and information regarding the qualifying event if you are applying during a Special Enrollment Period. Paperwork at the ready really accelerates things.

For SEP, missing paperwork can delay or deny your application. Get it all together early, check those dates twice, and keep duplicates for your records.

Think ahead to prevent lacunae. Save the date and study your state deadlines!

How to Compare Your Choices

Choosing individual health insurance in the U.S. Is about much more than just selecting a plan with a low monthly premium. The real difference is in the details—how much you’ll pay when you need care, if your favorite doctors are in-network, and how well the plan fits your life and health needs.

Smart comparison is about comparing more than price tags.

Network Access

Look over each plan’s network roster. Some plans have huge networks, others are much more limited. If you already have a doctor or specialist you trust, check out whether they’re in-network.

If you go out-of-network, you’ll pay a lot more – and sometimes services aren’t covered at all. Consider convenience as well. If your nearest in-network hospital, or urgent care, is far away — that could matter a lot, in an emergency.

Some coverage centers around major hospital networks in urban areas, while others include more local clinics. For instance, a plan with a UCLA Health network in L.A. Will likely have more local options than a smaller regional plan.

Coverage Level

Plans come in various levels of coverage – often named Bronze, Silver, Gold or Platinum. These tiers reflect how pricing is divided. Bronze plans tend to have lower premiums, but higher out-of-pocket costs, whereas Platinum plans cover more, but cost more each month.

Look at what’s actually covered: preventive care, emergency visits, mental health, maternity, or physical therapy. Big medical plans provide wide coverage for hospital and doctor care.

Catastrophic plans are for big, rare events but don’t help much with routine care. Basic plans might omit things such as prescriptions or rehab. Tailor the plan to you—someone who sees the doctor frequently could save more with a higher-coverage plan, even if it’s more expensive monthly.

Prescription Drugs

Prescription coverage varies between plans. Check the formulary — the list of covered drugs. Don’t forget any daily meds you may take. Some plans may for instance cover generic drugs but not name brands, or make you try less expensive drugs first.

Costs may also vary with each plan. Some have flat copays and some have coinsurance which means you pay a percent of the drug cost. If you take medicine monthly, having this cost information up front is important.

Prescription coverage can tip the scales if you have a chronic illness or rare condition.

Your Health Needs

Consider your current health and what you could require this year. If you have existing treatments or consult specialists, verify if those requirements are included. Other plans allow you to pick a primary care physician who will help direct your care, which is especially useful for those with complex conditions.

The healthiest among us can likely get away with a plan that just protects against major emergencies. Others will require support for ongoing appointments, labs or therapy. Match the plan to your health — not your wallet.

Navigating the Fine Print

Health insurance paperwork piles on quickly and gets complicated, especially with different types of health plans available. Most folks overlook crucial language in their health insurance plan, and that can result in surprise bills. To choose wisely, you’ll want to examine what’s excluded, how plans automatically renew, and what typical misconceptions stand in your way.

Hidden Exclusions

Secret carve-outs signify that certain therapies or diagnoses will not be covered by your plan, even if you assumed they would. Examples could be pre-existing condition waiting periods, certain drug exclusions, or caps on mental health visits.

Scan the fine print for stuff such as ‘not medically necessary’ or ‘experimental’. These can be red flags for declined claims.

Overlooking these exclusions can cost you big. Before you buy a plan, inquire about what’s not covered, waiting periods, and caps on stuff like rehab or therapy.

Always include your non-negotiables—like maternity or mental health—and ensure they’re not on the blacklist.

Renewal Rules

Renewal rules explain how your plan shifts from year to year. Health insurance isn’t always ‘set it and forget it.’ Your premium could increase, or coverage could shift.

Every year, check your plan at open enrollment. You’ll want to measure your existing coverage against alternatives so you don’t overlook superior bargains or emerging advantages.

Premiums and coverage may change every renewal. Occasionally, your insurer will switch the network, increase the deductible or adjust co-pays.

It’s tempting to think that nothing will be different, but that’s dangerous. If your requirements or wellness evolves, shop around. Claim settlement ratios of more than 85% is a good indicator that an insurer pays claims promptly.

Common Misconceptions

Most think health insurance pays for everything after the deductible. This isn’t the case. You’ll still have co-pays, co-insurance, and sometimes coverage caps.

A new poll revealed that the majority of Americans have no idea what these terms actually mean, which causes confusion in the doctor’s office.

Expenses such as premiums, out-of-pocket maximums and exclusions confuse people. Many believe every plan includes pregnancy or mental health, however that’s not necessarily so.

Being aware of these realities will help you sidestep both claim denials and sticker shock. Pass accurate information along to your friends and family, so they don’t get duped the same way.

Where to Purchase Your Plan

Individuals seeking individual health insurance have several options on how to shop for coverage. Your primary place to begin is the Health Insurance Marketplace, a government-sponsored website. This site allows you to view, compare, and purchase various health plans from different insurance providers.

It’s good for most states, and it’s designed to assist you in determining if you’re eligible for discounts based on your income. You can only register during the annual open enrollment period, which typically extends from November through mid-January. If you miss this window, you can still receive coverage if you qualify for a special enrollment period – like losing other coverage, moving to a new state, or having a baby.

Some folks will want to purchase a health insurance plan directly from an insurer. In which case, you can visit the company’s own site or call them to view the plans they offer. These plans are referred to as “off-exchange” since they aren’t sold on the government’s exchange.

Buying direct may mean more options, but these insurance plans don’t necessarily include the same government subsidies that keep costs down for many individuals. Off-exchange plans still must comply with state and federal coverage standards, but you cannot apply tax credits unless purchased through the marketplace.

Another route to locating a specific plan is through a licensed insurance agent or broker. These professionals know the industry and can assist you in aligning your healthcare needs to a plan. They can display to you marketplace and private alternatives, describe the coverage details, and shepherd you through the forms.

There are agents who represent a single company and brokers that can compare plans from multiple insurers. They don’t charge extra for using their assistance, as they are compensated by the insurer.

A lot of Americans receive health insurance coverage from their employer. If your employment covers, that’s worth verifying first. Employer plans tend to be less expensive as the company covers a portion of your monthly premium.

If you quit your job or freelance, you’ll have to consider the other options above, including short term health insurance plans. You can use private online health insurance marketplaces, known as private exchanges. They allow you to compare plans from multiple companies in one convenient location.

They operate somewhat like the official marketplace but may display additional plan types, such as temporary health insurance. Private exchanges don’t provide government subsidies, so you’ll pay the full price unless you’re eligible for assistance through the marketplace.

Conclusion

Obtaining health insurance in the U.S. For yourself can seem like a labyrinth, but it doesn’t have to mire you. They have bronze level basics all the way through to more full coverage so you can select something that fits your life and wallet! Costs vary a lot, so look at monthly bill and copays and what you pay before insurance kicks in. You can shop on state exchanges or directly from a company. It pays to review the rules and inquire about networks and prescription coverage. Take it slow, examine the fine print, and consider your alternatives. To find the right fit, begin with what you need most—then tailor a plan to your actual daily. Curious to read further? Contact or trust sites for updates.

Frequently Asked Questions

What is individual health insurance for one person?

Individual health insurance is a health insurance plan you purchase for yourself, not through an employer. It protects your physical health, covering medical services like doctor appointments, hospitalization, and medication.

How much does individual health insurance cost in Los Angeles?

Rates for health insurance plans differ depending on age, coverage, and plan type. In LA, they can range from $300 to $600 a month, although subsidies would reduce health insurance costs.

When can I enroll in an individual health insurance plan?

You may sign up for a health insurance plan during the Open Enrollment Period, typically from November to January. Special Enrollment applies if you experience certain life events, such as losing job coverage.

Where can I buy individual health insurance in California?

You may buy health insurance plans through Covered California (the state marketplace), directly from insurers, or through licensed agents and brokers.

What should I look for when comparing health insurance plans?

Look side by side at premiums, deductibles, out-of-pocket costs, covered benefits, and provider networks for different types of health plans. Verify your doctors and medications.

Are pre-existing conditions covered by individual health insurance?

Yes, all individual health insurance plans under the ACA cover pre-existing conditions, ensuring that health coverage is accessible regardless of your health status.

Can I get financial help to pay for individual health insurance?

Yes, if you are income qualified, you can get subsidies through Covered CA to lower your monthly premiums and out-of-pocket costs for health insurance plans.