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Individual Health Insurance


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Often referred to as “non-group” coverage, individual insurance is for people who are self-employed (and their dependent family members), as well as other people 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 prohibited as a result of the Affordable Care Act (ACA). 

Purchase options

Individual insurance available for purchase through:

  • Health Insurance Marketplace with  24/7 assistance available by calling 800-318-2596
  • State exchanges
  • Insurance companies directly, although tax credits that make them more affordable are only available with Marketplace coverage
  • 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

Covered services, medicines and equipment

By law, most individual policies must cover ten essential health benefits. This includes policies sold in the Marketplace, or directly through an insurer outside of the Marketplace.  All health insurance including Medicare and Medicaid plans must cover recommended preventive care (such as cancer screenings and vaccines) at no additional cost to you.    

Prescription and provider coverage

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. 


Generally, people who wish to purchase or switch health insurance plans must do so during an Open Enrollment period – for the Health Insurance Marketplace this is from November 1st to January 31st each year.  For coverage to begin on January 1st, make sure you enroll by December 15th. 

There are exceptions for those who have a qualifying event or qualify for a Special Enrollment opportunity due to certain circumstances such as moving out of state, getting married or having a baby.

Individuals or families with children but no health insurance can explore their eligibility for Medicaid or the Child Health Insurance Program (CHIP) for children under age 19 at any time.  There is no open enrollment period for Medicaid or CHIP; learn about and apply for these government-sponsored health insurance programs at


Premiums vary significantly depending on location, coverage, your age and whether or not you use tobacco.
  • Fortunately, all individual insurance plans sold through the Marketplace or state exchanges are available on an income scale. 
  • Plans are listed as Platinum, Gold, Silver or Bronze depending on coverage.
  • Additional financial help is available for Silver level plans for people with household incomes below 250% of the federal poverty level (as of 2014: $28,725 for a household of 1, or $58,875 for family of 4).

More about the Health Insurance Marketplace

The Affordable Care Act (ACA) of 2010 requires tax credits that make coverage more affordable and prohibits insurers from refusing to cover or charge more if someone has a pre-existing condition – including MS. Read about the Society’s healthcare reform principles and current advocacy issues.

The Health Insurance Marketplace, which may be referred to as the Exchange in some states, allows individuals and families to compare available health plan options, submit an application for health insurance and cost help, and enroll in their chosen health plan.
  • Everything you read about your options and costs will be in plain language.
  • Details about price, benefits, quality and other features are presented to help you select the plan that best meets your needs.
  • Every health insurance plan in the Marketplace offers comprehensive coverage, including hospitalization, doctors’ visits, prescriptions and more.
You can get help reviewing options and next steps through the toll-free 24/7 help line: 800-318-2596 (TTY: 855-889-4325). There is also an online chat service, as well as specially trained Navigators who offer unbiased information, education and enrollment assistance to consumers at no cost. If you experience difficulty accessing this toll-free help line, try one of the local help providers in your state or community. 

You must re-enroll every year. Every fall, your health insurance company will notify you of changes to premiums and benefits for the coming year. 
  • You can choose to stay in your current plan as long as it is still offered, or switch to another one that is a better fit for your needs and finances. 
  • You can begin comparing your options on November 15th but you only have until February 15th to enroll in a different plan. 
If you want to stay enrolled in your current plan, use the plan ID in the letter you get from your health insurer to quickly access your Marketplace account – which you will need to update or confirm your personal information.

Medicaid and CHIP enrollees must re-certify for continued coverage every year. Each state has its own process for recertifying enrollees in these programs. Watch for notices from your Medicaid or CHIP plan and follow the procedures carefully.

Call 800-318-2596 for help re-enrolling in Marketplace, Medicaid or CHIP health coverage.

Additional resources