Overview
Individual plans – also referred to as Individual Family Plans, or IFPs – are medical plans sold by insurance carriers directly to individuals, rather than through an employer or group plan. In the context of ICHRA, IFPs are the plans that employees purchase using their employer's allowance.
Context and History of Individual Plans:
Individual plans gained prominence after the Affordable Care Act (ACA) in 2010, which standardized the market by requiring insurers to accept all applicants, regardless of health status, and provide essential health benefits. The ACA eliminated practices like medical underwriting and ensured broader consumer protections, making IFPs more accessible and reliable for individuals seeking coverage outside of employer plans.
Key Features of Individual Plans:
Difference from Group Plans:
Unlike group plans offered by employers, individual plans allow for a high degree of customization. Individuals can choose from a wide range of coverage options, including different levels of deductibles, copayments, and out-of-pocket maximums. There are various plan types available, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs), allowing individuals to select the type of plan that best fits their needs and budget.Eligibility and Enrollment:
Most people can only enroll in individual plans during the annual Open Enrollment Period (OEP), which typically runs from November through December for coverage starting the following year. However, if an individual has a qualifying life event, such as gaining access to an ICHRA mid-year, they may be eligible for a Special Enrollment Period (SEP). This allows them to enroll in a plan outside the normal enrollment window. Other qualifying events include changes in family size (e.g., marriage or birth of a child), moving to a new area, or losing other health coverage.No Exclusions:
One of the key features of individual plans post-ACA is that everyone is accepted, regardless of their health status. There is no medical underwriting, meaning insurance companies cannot charge higher premiums or deny coverage based on pre-existing conditions or health history. This ensures that all individuals, including those with chronic health conditions, have access to comprehensive health insurance coverage without facing discrimination.
It is important to understand how IFPs are priced and structured in order to pick the plan best suited to your needs during the ICHRA onboarding process. You can read more about these topics in other articles in this section.