What Is Individual & Family Health Insurance?
Individual and family health insurance is coverage you buy directly, rather than getting it through an employer. In Texas, most people purchase this coverage through the ACA marketplace (Healthcare.gov), where you can compare plans from all major carriers and potentially qualify for premium tax credits that significantly reduce your monthly costs.
Whether you're self-employed, between jobs, early retired, or work for an employer that doesn't offer health benefits, individual and family plans provide comprehensive coverage for you and your household.
Who Needs Individual & Family Insurance?
Self-Employed & Freelancers
If you own your own business, work as an independent contractor, or freelance, you need to purchase your own health insurance. Many self-employed individuals qualify for significant premium tax credits.
Between Jobs
Lost your job or waiting for employer coverage to start? Individual plans provide immediate coverage. Job loss also qualifies you for a Special Enrollment Period outside of Open Enrollment.
Early Retirees
Retired before 65 (when Medicare starts)? Individual plans bridge the gap between employer coverage and Medicare eligibility. Premium tax credits are often available based on retirement income.
No Employer Coverage
Work for a small employer that doesn't offer health benefits? Or employer coverage is unaffordable? Individual marketplace plans may cost less with premium tax credits.
Types of Individual & Family Plans
ACA Marketplace Plans (Obamacare)
The majority of individual coverage in Texas is purchased through the ACA marketplace at Healthcare.gov. These plans offer several key advantages:
✓ ACA Marketplace Advantages
- Premium Tax Credits: Most people qualify for subsidies that reduce monthly premiums
- Cost-Sharing Reductions: Additional help with deductibles and copays for lower incomes
- Guaranteed Coverage: Can't be denied for pre-existing conditions
- Essential Health Benefits: All plans cover 10 categories of care
- No Lifetime Limits: Protection from catastrophic medical bills
- Preventive Care: Annual checkups and screenings covered at 100%
Metallic Plan Levels
ACA marketplace plans come in four metal levels: Bronze, Silver, Gold, and Platinum. The level determines how you and the plan split costs:
| Metal Level | Plan Pays | You Pay | Best For |
|---|---|---|---|
| Bronze | 60% | 40% | Healthy, minimal care needs |
| Silver | 70% | 30% | Most people, especially with CSR |
| Gold | 80% | 20% | Regular healthcare use |
| Platinum | 90% | 10% | Significant medical needs |
Choosing Your Metal Level
Lower metal levels have lower premiums but higher out-of-pocket costs. Higher metal levels cost more monthly but pay more when you need care. We can help you calculate which level saves you the most money based on your expected healthcare needs.
Off-Marketplace Plans
Some insurers offer plans outside the marketplace. However, you cannot use premium tax credits with off-marketplace plans. These are generally only recommended if you don't qualify for subsidies and want coverage features not available on the marketplace.
Short-Term Medical Insurance
Short-term plans provide temporary coverage (up to 3 months in Texas) for gaps in coverage. They're less expensive but don't cover pre-existing conditions, don't include Essential Health Benefits, and don't qualify you for premium tax credits.
Premium Tax Credits: How Much You Can Save
Premium tax credits (subsidies) are the key to affordable ACA marketplace coverage. If your household income falls between 100% and 400% of the Federal Poverty Level, you likely qualify.
2024 Income Limits for Premium Tax Credits
| Household Size | 100% FPL | 400% FPL |
|---|---|---|
| 1 Person | $15,060 | $60,240 |
| 2 People | $20,440 | $81,760 |
| 3 People | $25,820 | $103,280 |
| 4 People | $31,200 | $124,800 |
| 5 People | $36,580 | $146,320 |
Income between these amounts qualifies for premium tax credits. Many people above 400% FPL also qualify for some assistance under current law.
How Much Can You Save?
Premium tax credit amounts vary based on your income and location. Many families save hundreds of dollars per month. Some examples:
- Family of 4 earning $50,000: Often pay $50-200/month after tax credits
- Single person earning $35,000: Typically pay $50-150/month after tax credits
- Early retiree couple earning $45,000: May pay $100-300/month after tax credits
When & How to Enroll
Open Enrollment Period
November 1 - January 15
The annual Open Enrollment Period is when anyone can enroll in or change ACA marketplace plans. Coverage typically starts January 1st (or February 1st for late enrollments).
Special Enrollment Periods
Outside Open Enrollment, you need a qualifying life event to enroll:
✓ Qualifying Events
- • Lost employer coverage
- • Marriage or divorce
- • Birth or adoption
- • Moved to new area
- • Gained citizenship
- • Income change affecting subsidies
⏱ Enrollment Window
You typically have 60 days from your qualifying event to enroll. Some events (like birth) provide coverage retroactive to the event date.
How to Choose the Right Plan
With dozens of plans available from multiple carriers, choosing can feel overwhelming. Here's what to consider:
The #1 factor: Are your current doctors in-network? We verify this before recommending any plan. Plans with broader networks cost more but offer more choice.
Check if your medications are on the plan's formulary (drug list) and what tier they're on. Generic drugs are usually cheap, but specialty medications can vary dramatically between plans.
Don't just look at premiums. Add up: monthly premium + expected medical costs (copays, deductible) to get your true annual cost. Sometimes a Gold plan with higher premiums costs less overall than Bronze.
Healthy with few needs? Bronze might work. Regular doctor visits or chronic conditions? Gold or Platinum could save money. Planning pregnancy? Maternity coverage is essential.
Major Texas Carriers
As independent agents, we work with all major carriers operating in Texas:
Blue Cross Blue Shield TX
Molina Healthcare
Oscar Health
Ambetter
Community Health Choice
Friday Health Plans
Sendero Health Plans
And More
Get Your Free Quote Today
Ready to find affordable health insurance for you and your family? I can help you:
- Check your premium tax credit eligibility
- Compare plans from all Texas carriers
- Verify your doctors are in-network
- Check prescription drug coverage
- Calculate your total annual costs
- Enroll in your chosen plan
Get Your Free Individual & Family Insurance Quote
With 30+ years of experience helping Texas families, I'll find you the best coverage at the best price. No cost, no obligation, no pressure.