Individual Health Insurance - National Multiple Sclerosis Society

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Individual Health Insurance

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Overview

Often referred to as “non-group” coverage, individual insurance is now available for people who are self-employed and their dependent family members, as well as others that are not eligible for coverage from other sources, such as job-based group health plans, Medicare or Medicaid.  Denials or restrictions in coverage, and higher premium rates due to a pre-existing condition or disability are now prohibited as a result of the Affordable Care Act (ACA). 

Where can I find out about my individual insurance options?

Individual insurance is available for purchase through the Health Insurance Marketplace or exchange in your state.  Insurance companies may sell individual policies directly, although tax credits that make them more affordable are only available with Marketplace coverage.  Learn about available plans in your area and to how to apply through any of the following:

  • The online Health Insurance Marketplace
  • Marketplace telephone assistance is available 24 hours a day, 7 days a week at 800-318-2596
  • An insurance agent or broker licensed by your state
  • In some communities, information and enrollment help is available at certain hospitals, clinics, pharmacies or community service organizations - See ‘Find Local help’ at HealthCare.gov

What services, medicines and equipment are covered by individual insurance policies?

By law, most individual policies must cover ten essential health benefits, including policies sold in the Marketplace, or directly through an insurer outside of the Marketplace.      

Will my MS drug be covered? What about my doctor?

You may have to do extra research to find out if your doctor, hospital or specific medications are covered by any of the individual plans you are considering.  These and other details should be available through your state’s online Marketplace or the insurance company.  This application checklist (.pdf) helps people with MS and their families considering an individual health plan. 

How much does individual coverage cost?

Individual plan premiums vary significantly depending on their location, the amount of coverage provided, the applicant’s age, and whether the applicant uses tobacco. Fortunately, all individual insurance plans sold through the Marketplace or state exchanges are available on a sliding scale, based on income.  Depending on the amount of coverage provided, all plans are listed as Platinum, Gold, Silver or Bronze. Additional financial help is available for Silver level plans for people with household incomes for  people with household income below 250% of the federal poverty level ($28,725 for a household of one, or  $58,875 for four in 2014).

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The Affordable Care Act

Learn more about the changes to health insurance as a result of the ACA and download fact sheets on buying health insurance. 

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