Private Medical Insurance 101: What You Need to Know About Individual Health Insurance Plans

Individual health insurance plans are becoming increasingly popular among American adults. Employer-sponsored health plans have been the traditional route for many employees. However, as more workers switch to self-employment or part-time hours, private medical insurance plans fill the gap in health care for those who do not qualify for employer-sponsored plans.

One of the perks of individual health insurance is that it is far more customizable than employer-sponsored plans, which are typically provided with pre-determined coverage options. Learn more about private medical insurance plans below.

What is Personal Health Insurance?
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Private health care refers to plans and options that are not sponsored or provided by an employer or other large-scale organization. Some groups may also provide health care plans, such as a union or trade organization.

Under federal law, the government requires all businesses with 50 or more employees to provide medical coverage for at least 90 percent of their full-time workers. 30 hours a week or more is considered full-time employment. 

Individual health insurance provides coverage for those who are not employed by a business or do not belong to a group that offers group coverage.

Enrolling in a private medical insurance plan is a bit different than enrolling in a group plan. For example, when you start a new job that offers health care, you can typically enroll in a coverage plan right away. When you choose to enroll in an individual health insurance plan, you can only enroll during a certain time of the year.

This open enrollment period takes place at the end of every year. Once you enroll in a plan, your coverage will not begin until the new year.

However, you may be able to enroll in an individual health insurance plan any time throughout the year if you qualify for a special enrollment period, or SEP. To be eligible for a special enrollment period, you must meet the conditions of a “qualifying event,” which include any of the following:

  • Getting married or divorced.
  • Experiencing a birth or death in your immediate family.
  • Losing medical coverage – such as losing your job, disenrolling from school, getting dropped from your parents’ plan or losing coverage from a government assistance program. 
  • Moving to a different zip code.
  • A change in your income – for example, an increase to your income could make you ineligible for low-income coverage plans.
  • Becoming a United States citizen.
  • Getting out of jail

If you do not qualify for any of the above, you must wait to enroll in a private health care plan until the end of the year.

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By Admin