When it comes to individual health coverage, are you aware of everything you need in your plan? Join us as we provide a quick guide for determining what you might require in a personal health insurance plan.
Ask Yourself: What Care Are You Using?
Choosing a plan starts with understanding your health needs. Ask yourself: Do you take regular medications? Do you need specialist visits, lab tests, or mental health care? Are you planning a family? The ACA mandates that all Marketplace individual plans cover 10 Essential Health Benefits—like prescription drugs, mental health services, and maternity care. Make a list of what matters most to you—from ADHD meds to diabetic supplies—and ensure your shortlist of plans aligns with your real-world needs.
Individual Health Coverage: What Should You Look For?
- Prescriptions & Chronic Care: All plans must include drugs, but formularies vary. Check that your regular medications are covered and review co-pays or coinsurance levels.
- Free Preventive Care: Non-grandfathered plans cover services graded “A” or “B” by the USPSTF—like colonoscopies, mammograms, flu shots, and hypertension screening—without cost-sharing, provided you stay in-network.
- Service Networks & Out-of-Pocket Safeguards: Know whether your preferred doctors are in-network or not (HMO, PPO, etc.). Be clear on deductibles, co-pays, coinsurance, and the maximum you’d pay annually before 100% coverage kicks in.
- Protections: No plan can deny you for pre-existing conditions, drop coverage when you’re sick, or impose lifetime or annual cost caps on Essential Health Benefits.
Make It Personal: Match Your Plan to Life
- List your health priorities—meds, specialist visits, planned procedures.
- Compare Summary of Benefits & Coverage (SBC) sheets. Does the plan fully meet your needs? Will your meds fall into high-cost tiers?
- Balance premiums vs. expected usage. If you rarely need care, a Bronze or high-deductible plan might save money. Frequent users often benefit from Silver or Gold plans that reduce per-visit costs.
- Double-check provider access—especially for specialists or mental health support.
- Add it up. Estimate your yearly out-of-pocket cap. Would you be comfortable paying that if you needed it?
In Summary
By listing your specific needs, verifying what’s included (and what’s not), and weighing costs realistically, you’ll find a health plan that fits you—not just a generic template.
Have Health Insurance Questions?
We hope that this information on health coverage is helpful for you.
Insurance is oftentimes overwhelming, and we want to shed light on the industry by answering your questions. Comment below, and your question may be the topic of our next post!
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Empower Brokerage wants to help you find the insurance coverage you need and help you save money getting it. Stay on top of your health and give us a call at (844) 410-1320.
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