What to know about Individual & Family Plans

Finding the right health care coverage for your needs may be confusing. You might have heard about health insurance through the exchanges, also known as health care marketplaces, but perhaps like many other uninsured Americans, you assumed coverage would be too expensive. 

The fact is, millions of Americans remain uninsured, despite qualifying for assistance — and there are more coverage options than ever before. To help explain what these plans could mean for you and your family, Marcus Robinson, CEO for Individual & Family Plans at UnitedHealthcare, answers a few questions about these types of plans and how to enroll in them.

How does the Inflation Reduction Act change the health care marketplace?

A couple of things. First, subsidies have been extended through 2025 and many consumers are now eligible for coverage with a $0 premium or for lower premiums depending on their income. For a long time, subsidies were unavailable to individuals with incomes at or above 400% of the federal poverty level. Through 2025 that “subsidy cliff” has been removed, and instead individuals’ contribution towards premiums is capped at no more than 8.5% of their income, with subsidies available to cover the rest.

Can you explain what the exchanges are?

The health care exchanges on healthcare.gov or certain state-based sites (sometimes referred to as the marketplace) provide access to shop and enroll in health plans for individuals and families. Depending on the state, the exchange might be run by the federal government, the state itself, or a combination of the two.

Plans on the exchange have tiers such as gold, silver and bronze. Can you break down the difference between the “metallic” levels?

The “metal” level indicates the richness of the insurance coverage. For example, the bronze level is going to have the most cost-effective plans — lower premiums, but higher out-of-pocket costs (such as deductibles, coinsurance or copayments) when a member seeks care. The gold level, on the other hand has higher premiums but lower out-of-pocket costs.

Which levels of plans do the subsidies apply to?

You get to choose. Once you have qualified for a subsidy amount, you can take that subsidy and shop for any type of plan design you choose. For example, you could use your subsidy with a bronze or silver plan and potentially have a plan with zero premium depending on your income level. In addition to the premium subsidies described above, some individuals may also qualify for another form of subsidy called Cost-Sharing Reductions (“CSRs”) depending on their income. These CSRs help reduce the amount that an individual has to pay out-of-pocket toward deductibles, coinsurance, and copayments. It is important to note that CSRs are only available on plans at the silver metallic level. 

What do you recommend for those who might be new to this?

Health care is personal. You want to look at how frequently you use health care, what medications you take and what the cost of them might be — and keep that in mind while shopping. You also might want to look at what physicians and hospitals are in network. Many plans may offer virtual visits at no additional cost or offer wellness and value-added benefits. Highlights of some Individual & Family plans with UnitedHealthcare may include:1

  • $0 unlimited primary and virtual urgent care visits2
  • Prescriptions as low as $3 at Optum Rx Home Delivery
  • Tier 1 drugs for as low as $3 at Walgreens and 20% off Walgreens-brand health and wellness products3
  • Dental and vision coverage for adults4

You can always learn more about Individual & Family ACA Marketplace plans (or in Spanish) or contact 1-877-649-9797 / TTY 711 to get help with finding the best plan for you.

When can people shop for a plan? Is there a specific enrollment period?

In most states, open enrollment will end Jan. 15, 2023. If you want your coverage active on Jan. 1, 2023, make sure that you enroll by Dec. 15, 2023. Enrollments completed between Dec. 16 and Jan. 15 will have coverage effective Feb. 1, 2023.

How do you enroll in a plan? What if someone has barriers to access a computer?

You can learn more about this type of coverage at uhc.com/marketplace (or in Spanish) or you can call 877-649-9797 / TTY 711 to speak with enrollment specialists about the plans UnitedHealthcare offers in your area.

Most areas have navigators and assistors available in multiple languages or you can find licensed agents at Health Markets, who can help people enroll in all types of plans.

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