Is an Individual Plan Right for You? Assessing Your Options

Whether you’re new to health insurance, switching from a group plan, or looking for cost assistance (sometimes known as subsidies), several innovative organizations with cutting-edge technology make it easier to shop and choose the right individual plan.

Individual plans are policies purchased for yourself or your family on your own rather than through an employer and can be bought either through a broker or on a state/federal health exchange/marketplace.


Making an intelligent choice for your individualized care plan requires effort, but the time invested now will provide benefits in the future. Fortunately, there are plenty of resources to help you navigate the process, including insurance brokers and healthcare navigators. They can provide personal assistance with on-exchange and off-exchange plans and Medicaid enrollment.

Before you select a policy, you should list your health requirements and decide what coverage options are important to you. Then, compare costs and benefits to find the best deal. Individual health insurance policies may have different sub-limits for various covers, so you should ensure that your selected plan meets your coverage expectations without exceeding your budget.

Another consideration is the type of plan design. Typically, employer-sponsored health insurance plans are PPOs with broad provider networks, while individual insurance plans are more likely to be HMOs or EPOs with narrow networks. Moreover, individual health insurance plans are less likely to include out-of-network benefits, and you may need a referral to see a specialist with certain types of individual health plans.

Finally, consider whether you are eligible for cost assistance (subsidies). These are available for people purchasing health insurance through the ACA exchanges. However, you can also receive these financial incentives by shopping directly from a health insurance carrier or a broker offering non-ACA plans.


When choosing a health plan, it is essential to consider your individual needs and budget to find the best coverage. Individual 401k plan are usually more expensive than group health insurance offered through an employer, but they can provide the coverage you need to protect against rising medical costs.

If you are transitioning from group health insurance through your employer to an individual plan, consider how flexible you want the plan to be. Some plans, such as HMOs and PPOs, have a restricted network of hospitals and doctors that you must use for services. Specific healthcare plans may require a referral from your primary care physician, whereas others offer medical care outside the network.

Another consideration is whether you want to buy a long-term or short-term plan. Long-term plans have higher premiums but cover many services, including prescription drugs and mental health. Short-term plans are less expensive but do not cover maternity, drugs, or other services.

Suppose you need help to afford the cost of an individual plan. In that case, you may qualify for a subsidy to make it affordable through the ACA marketplace or directly from Medical Mutual. The best time to assess your options for a new individual health plan is during the open enrollment period in the fall of each year.

Choice of Insurer

When you purchase individual health insurance, it’s essential to carefully consider what kind of coverage meets your needs and budget. It would be best if you also considered how much flexibility you want in your plan. Individual plans are not tied to an employer’s plan, so you may have more options for choosing a healthcare provider and coverage type than when your employer makes the decisions for you.

For example, you can choose between HMOs and EPOs in the individual market, while you generally only have PPOs in the employer-sponsored marketplace. You can also purchase supplemental coverage to enhance your coverage with an individual plan, such as dental or vision coverage.

In addition, you’ll need to decide whether or not you want to shop in the exchanges to see if you qualify for cost assistance, also known as subsidies. You can find more individual plan options if you search outside the exchanges, but those plans may not be eligible for subsidy support.

Working with an experienced agent who can help you navigate your options and choose the best approach for your situation is recommended. 

Preventive Care

Individual health plans are available through your employer, a private insurance broker, or the state health insurance exchange (a health insurance marketplace). When choosing an individual plan, you have more control over selecting benefits and insurers. If you have been relying on an employer-sponsored group plan, consult an experienced insurance broker or an insurance navigator to help you understand your options.

A health plan can include preventive care and cover the treatment costs for illness and injury. Preventive care includes regular checkups and health screenings to identify medical problems at an early stage when they are easier to treat and less costly. It also includes education and counseling to encourage healthy lifestyle choices.

Most health plans typically cover preventive services, valid for those offered through the Health Insurance Marketplace. These services are based on recommendations from several trusted sources, including the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, the Health Resources and Services Administration’s Bright Futures Project, and the Women’s Preventive Services Initiative. As a result, you can be assured that these services are essential and beneficial for your overall health and well-being.

The type of individual health plan you choose depends on your preferences for cost and coverage. For example, some individual plans have higher monthly premiums but lower out-of-pocket costs when you visit the doctor. Other plans have lower premiums but require you to pay a higher share of the cost of your care, especially when you need to see a specialist or hospital.