What are individual health plans?
Individual health plans are health insurance policies that individuals purchase on their own, rather than receive through an employer or government program. These plans are available through health insurance marketplaces (the “Exchanges”) or directly from insurance companies. They are often referred to as Individual and Family Plans (IFPs).
Types of IFPs
IFPs can vary according to multiple factors:
Coverage levels (also referred to as "metal levels" or "tiers")
Metal levels indicate the comprehensiveness of a plan in terms of the share of healthcare expenses that it usually covers. Metal Levels range from bronze (lean), silver (basic), and gold (expanded) to platinum (most comprehensive).
Network type
Networks are the set of providers and facilities that the insurance carrier has negotiated special pricing with for a particular plan. The network type determines the way members access healthcare services, and whether members need to seek approval from a Primary Care Physician (PCP) before getting additional care.
Health Savings Account (HSA) eligibility
Some plans with high deductibles are HSA-eligible, which means a tax-preferred HSA account can be maintained with them. It's important to note that the health plan itself does not include an HSA, only the eligibility to open or maintain a separate HSA.
How are IFPs priced?
First, it’s important to understand how they’re NOT priced. IFPs cannot be priced according to a person's medical history, gender, or any other personal attributes. This is part of the Affordable Care Act mandate to allow all individuals to obtain coverage and prevents insurance carriers from discriminating against anyone.
IFPs do vary in price, but according to four factors only: age, family size, geography, and smoking status. This means that two single, non-smoking individuals of the same age and in the same zip-code will always receive the same price for a given health plan.
Read more about the elements that determine IFP pricing here.