Under 65

Individual Health Insurance (ACA)

Not on Medicare yet? Individual and family plans through the Affordable Care Act marketplace cover you until you turn 65. No health questions, no denial for pre-existing conditions — and most households qualify for help paying the premium.

Guaranteed issueNo medical underwriting — you cannot be turned down

Nov 1 – Jan 15Annual Open Enrollment on the federal marketplace

Income-basedPremium tax credits lower what you actually pay each month

Who Individual Health Insurance Is For

If you're under 65 and don't have coverage through an employer, this is your path. It's also the plan we set up most often for the spouse who isn't 65 yet when the other one goes on Medicare.

Retiring Before 65

You stopped working at 62 and Medicare is still three years away. A marketplace plan bridges the gap without the COBRA price tag.

A Spouse Under 65

You're going on Medicare but your spouse isn't there yet. When the family plan ends, they need their own coverage — and that loss of coverage opens a Special Enrollment Period.

Self-Employed or 1099

There's no employer plan to fall back on. Once premium tax credits are applied, marketplace coverage is usually the most affordable route.

Between Jobs

COBRA lets you keep your old plan, but you pay the entire premium yourself. A marketplace plan is often a fraction of the cost for comparable coverage.

The Four Metal Levels

Every marketplace plan is sorted into a metal level. The metal tells you how the bill gets split between you and the carrier — not how good the care is. All four cover the same essential benefits.

Bronze

Lowest premium, highest deductible — the plan pays roughly 60% of covered costs. Best if you rarely see a doctor and mainly want protection from a catastrophe.

Silver

The middle option — the plan pays roughly 70%. The only level where cost-sharing reductions apply, which can sharply lower your deductible and copays if your income qualifies.

Gold

Higher premium, lower deductible — the plan pays roughly 80%. Often worth it if you take regular medications or see specialists.

Platinum

Highest premium, lowest out-of-pocket — the plan pays roughly 90%. Not offered by every carrier in every county.

Silver is worth a second look

Most people shop on premium alone and land on Bronze. But if your household income falls in the range that qualifies for cost-sharing reductions, a Silver plan can end up with a lower deductible than Gold — at a Silver price. That help only attaches to Silver plans, and it's the most commonly missed savings in the marketplace.

What Every ACA Plan Covers

Ten categories of essential health benefits are required by law — in every marketplace plan, from every carrier, at every metal level.

Included in Every Plan

Doctor visits and outpatient care
Emergency services
Hospitalization and surgery
Prescription drugs
Lab work and diagnostics
Maternity and newborn care
Mental health and substance use treatment
Rehabilitative services and devices
Pediatric dental and vision
Preventive care and chronic disease management — at no cost to you

Protections That Come With It

No health questions on the application
Pre-existing conditions covered from day one
You can't be charged more for being sick
No annual or lifetime dollar caps on essential benefits
Every plan has an out-of-pocket maximum — once you reach it, the plan pays 100%
Adult children can stay on a parent's plan to age 26

When You Can Enroll

Unlike Medicare, the marketplace has one annual window — plus special windows that open when your life changes.

Nov 1 – Jan 15

Open Enrollment on the federal marketplace. A few state-run marketplaces, New Jersey among them, run later — we'll confirm the dates for your state.

Enroll by Dec 15

Coverage starts January 1. Enroll after that and coverage typically starts the first of the following month.

Life events

A Special Enrollment Period opens for 60 days after you lose coverage, marry or divorce, have or adopt a child, or move permanently.

Miss the window

Without a qualifying life event you wait for the next Open Enrollment — a gap that can run most of a year.

Turning 65 while on a marketplace plan?

Tell us early. Your premium tax credit generally ends once you're eligible for premium-free Medicare Part A, and dropping the marketplace plan at the wrong moment can leave you with a coverage gap or a lifelong Part B late-enrollment penalty. We coordinate the handoff so the two line up to the day.

Not sure which plan is right for you?

Book a free 45-minute call with a licensed agent. We'll check what you qualify for, compare plans side-by-side, and help you choose — with zero pressure.

Book a Free Consultation →