What Are Individual and Family Health Insurance Plans?

Individual and family health insurance plans are ACA-compliant health coverage purchased by individuals and families directly — rather than through an employer or government program like Medicare or Medicaid. These plans are available through the Health Insurance Marketplace (HealthCare.gov or your state's equivalent) and from insurance companies directly.

The ACA Marketplace is the primary destination for individual and family coverage because it is the only place where you can access premium tax credits and Cost-Sharing Reductions — the federal financial assistance programs that make coverage affordable for millions of Americans. If you do not have access to affordable employer-sponsored coverage, Medicare, or Medicaid, a Marketplace plan is almost certainly your best option.

Who Needs an Individual or Family Plan?

You should consider an individual or family Marketplace plan if you fall into any of the following categories:

• You are self-employed or a freelancer without access to employer-sponsored coverage.
• Your employer does not offer health insurance, or the offered plan is unaffordable.
• You recently left a job and need to replace your employer-sponsored coverage.
• You are between jobs or in a career transition.
• You are a part-time worker who does not qualify for employer benefits.
• You are a recent college graduate who has aged off your parents' plan.
• You are a small business owner who does not qualify for group coverage.

Coverage for Children: What the ACA Requires

Family plans on the ACA Marketplace cover all members of your household, including children. Under the ACA, all plans must cover children up to age 26 on a parent's plan, regardless of whether the child is a student, married, or financially independent. This provision has allowed millions of young adults to maintain coverage during a period of life when they might otherwise go uninsured.

For children under 19, dental coverage is an essential health benefit that must be offered — either embedded in the health plan or as a separate stand-alone dental plan. Vision coverage for children (routine eye exams and eyeglasses or contacts) is also an essential health benefit. Adult dental and vision coverage is not required under the ACA, though many plans offer it as an add-on.

How Family Premiums and Deductibles Work

Family health plans have both individual and family deductibles and out-of-pocket maximums. Understanding how these work together is important for managing your family's healthcare costs.

Subsidy Eligibility for Families

Premium tax credits for family plans are calculated based on your total household income and the number of people in your household. The more people in your household, the higher the FPL threshold for subsidy eligibility — meaning larger families can earn more and still qualify for significant financial assistance.

A family of four with a household income of $80,000 may qualify for a substantial premium tax credit, making a comprehensive Silver or Gold plan very affordable. A family of four earning $100,000 may still qualify for some level of subsidy if the benchmark Silver plan in their area would cost more than 8.5% of their income.

The Importance of Choosing the Right Plan for Your Family's Needs

Choosing a family health plan requires balancing the needs of every household member. A plan that is ideal for a healthy adult may be inadequate for a child who needs regular specialist care or a family member with a chronic condition. When comparing family plans, consider the specific healthcare needs of each member, the plan's pediatric benefits, the prescription drug formulary for any medications family members take, and whether your family's preferred doctors and specialists are in-network.

Our FFM-certified agents specialize in helping families navigate the plan selection process. We can review your family's specific needs, run subsidy calculations, and help you find the plan that provides the best coverage at the lowest total cost. Call 888-982-0356 for a free family coverage consultation.