Individual & Family Insurance
If you buy your own coverage, the hard part is not the application. It is choosing between plans that look alike on paper and behave very differently at the doctor office.
Who it is for
Anyone whose coverage does not come from an employer – and anyone whose employer coverage is about to end.
- Self-employed people, consultants and 1099 contractors
- Employees who just left a job and are weighing COBRA against a Marketplace plan
- Families where one spouse has coverage and the other does not
- Early retirees who are not yet 65 and Medicare-eligible
- Adult children ageing off a parent plan at 26
- Part-time and seasonal workers who are not benefits-eligible at work
What is covered
Individual major medical, on and off the Marketplace:
- Covers the ten essential health benefit categories
- Cannot decline you for pre-existing conditions
- Bronze, Silver, Gold and Platinum metal tiers
- Higher tiers trade premium for lower out-of-pocket costs
Major medical
- Doctor visits, hospital, emergency care, prescriptions
- Maternity, mental health and preventive care
- No cost sharing on in-network preventive visits
Network design
- Most plans today are HMO or EPO
- Out-of-network care covered only in emergencies
- Checking your doctors matters more than premium
Dental and vision
- Adult dental and vision sold separately from medical
- We pair a standalone plan with medical
- Whole family covered in one arrangement
Gap protection
- Accident and critical illness plans pay you cash
- Softens a high-deductible Bronze plan
- Far cheaper than moving up a tier
How AIS helps
A licensed broker costs you nothing extra – the premium is identical either way. And you get someone to call when a claim is processed wrong.
- Subsidy check. We look at whether your household income and family size make you eligible for an advance premium tax credit, and what happens if your income changes mid-year.
- Doctor and drug check. We verify your physicians, hospital and prescriptions against each plan network and formulary before you enroll, not after.
- Total cost, not premium. We compare deductible, out-of-pocket maximum and copays against how your family actually uses care.
- Enrollment windows. We track Open Enrollment for you and identify whether a job loss, marriage, birth, move or loss of other coverage opens a Special Enrollment Period.
- After you enroll. Billing problems, ID cards, terminations and carrier disputes are still ours to work.
COBRA or an individual plan?
When employer coverage ends, you generally have both options.
- COBRA keeps your exact plan and network
- Individual plans often cost less – doctors may differ
- Depends on deductible year, treatment and subsidy eligibility
- We lay out both with real numbers
Individual major medical is normally sold during the annual Open Enrollment
window. Outside it you need a qualifying life event – losing other coverage,
marriage, divorce, birth or adoption, or a permanent move – which opens a
Special Enrollment Period with a limited number of days to act.
Not on ACA-compliant major medical – those plans cannot decline you or
charge you more because of health history. Short-term and fixed-benefit products
are a different matter, which is one reason we are careful about suggesting them.
No – premiums for the same plan are set by the carrier and filed with
the state, so the price is identical either way. The difference is having someone
accountable when something goes wrong.
Bronze works for a household that rarely uses care and can absorb the
deductible; it hurts if someone is in ongoing treatment. We model your likely
usage against Silver and Gold before recommending anything.
Advance premium tax credits are based on estimated annual income and are
reconciled on your tax return. If your income rises or falls materially, tell
us - updating the estimate during the year is much easier than settling a
large difference in April.
Related