Individual & Family
Health Insurance
Whether you're self-employed, between jobs, or shopping outside of work, we help you find the right coverage — with real guidance, not a confusing website and a chat bot.
Coverage That Works for Your Life
Individual and family health insurance can be confusing — between the ACA marketplace, off-marketplace plans, and supplemental options, there's a lot to navigate. We simplify the process and help you find the right fit for your situation and budget.
ACA Marketplace Plans
Also known as "Obamacare" plans, these are purchased through the federal or state marketplace during Open Enrollment or a Special Enrollment Period. Many people qualify for premium tax credits that significantly reduce monthly costs.
- Available year-round with qualifying life events
- Premium tax credits based on income (APTC)
- Essential health benefits always included
- No medical underwriting — can't be denied coverage
- Metal tiers: Bronze, Silver, Gold, Platinum
Off-Marketplace Plans
Some carriers offer ACA-compliant plans directly — not through the marketplace. These may offer different networks, plan designs, or pricing than marketplace options. They're subject to the same ACA rules but not eligible for tax credits.
- ACA-compliant, same protections as marketplace plans
- Sometimes offer broader or different provider networks
- Available year-round (not limited to enrollment windows)
- Best for those who don't qualify for marketplace subsidies
- Can offer more carrier and plan variety
Supplemental & Gap Plans
Supplemental plans fill coverage gaps left by major medical insurance. They're especially valuable if you're on a high-deductible plan or want additional financial protection against serious health events.
- Accident insurance — cash benefit for covered injuries
- Critical illness — lump sum on diagnosis of serious illness
- Hospital indemnity — daily benefit during hospital stays
- Dental & vision riders
- Gap insurance to cover deductibles and out-of-pocket costs
Understanding ACA Plans
Metal Tiers Explained
ACA marketplace plans are organized into four "metal" tiers that describe how costs are split between you and the insurance company. It's not about quality — it's about how you pay for care.
Premium Tax Credits (APTC)
Advanced Premium Tax Credits (APTC) are subsidies that reduce your monthly premium. Your eligibility is based on your household income relative to the Federal Poverty Level (FPL). The American Rescue Plan expanded these credits significantly, and many people qualify for more help than they realize.
Importantly, you must enroll through the marketplace (Healthcare.gov or your state exchange) to receive premium tax credits — off-marketplace plans are not eligible.
When Can You Enroll?
The ACA marketplace has a yearly Open Enrollment Period, typically running from November through mid-January. Outside of OEP, you can only enroll if you experience a qualifying life event that triggers a Special Enrollment Period (SEP).
Common SEP triggers include losing job-based coverage, moving to a new area, getting married, having or adopting a child, and changes in household income. We help you identify and document qualifying events to ensure timely enrollment.
Individual vs. Group Coverage: Which Is Right for You?
Sometimes the choice is clear. Sometimes it depends on your specific situation. Here's a side-by-side comparison to help you think it through.
| Factor | Individual / ACA Marketplace | Group (Employer-Sponsored) |
|---|---|---|
| Who pays the premium? | You pay the full premium (minus any tax credits) | Employer pays part; employee pays the rest (typically 50–80% employer) |
| Can you be denied? | ✓ No — ACA prohibits denial for pre-existing conditions | ✓ No — group plans are guaranteed issue |
| Subsidies available? | ✓ Yes, if income-eligible via the marketplace | ✗ No — employer-sponsored coverage is not subsidy-eligible |
| Enrollment timing | Open Enrollment (Nov–Jan) or SEP only | Any time of year; employees enroll within 30–60 days of hire |
| Network flexibility | Varies by plan (HMO, PPO, EPO) | Varies by plan; may include national networks |
| Best for... | Self-employed, part-time workers, those not offered group coverage | Full-time employees, business owners offering coverage to their team |
Build Complete Protection with Supplemental Plans
Even the best health insurance plan leaves gaps. Supplemental coverage fills those gaps and provides financial protection that your major medical plan alone cannot.
Accident Insurance
Pays a fixed cash benefit when you or a covered family member suffers a covered accidental injury. Benefits can be used for anything — medical bills, rent, or daily expenses while you recover. Especially valuable for active individuals and families.
Critical Illness Insurance
Provides a lump-sum cash payment upon diagnosis of a covered serious illness such as cancer, heart attack, stroke, or kidney failure. Use the benefit however you need — medical treatment, travel costs, or lost income while you focus on recovery.
Hospital Indemnity
Pays a fixed daily or per-admission benefit when you're hospitalized. Helps cover the deductibles and out-of-pocket costs that even good health insurance doesn't fully absorb. Often the most practical supplemental plan for everyday families.
Dental & Vision Riders
Individual dental and vision plans provide coverage that most major medical plans don't include. From annual exams and cleanings to major dental work, frames, and contacts — standalone dental and vision plans provide predictable, useful coverage.
Let's Find the Right Plan for You
No forms to fill out on your own. No hours on Healthcare.gov. Just call Paul and let's figure out your best options together.
Book a Free Individual Plan Review
Pick a time and Paul will walk you through your options. No obligation, no phone trees.