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Home > Health Insurance Basics > HMOs, PPOs & Other Health Insurance > Individual Coverage

Individual Coverage

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A health plan you buy yourself is called an individual plan, even if you are buying the plan for more than one person in your family. Many insurance companies sell individual health plans.

The laws that regulate individual plans are different from the laws that regulate group plans.

Changes regarding individual plans

In the past, people with a health problem often had trouble buying an individual plan. However, changes in the law have made it easier for more people to get an individual plan with better benefits.

  • There are protections for people with pre-existing conditions when they apply for an individual plan.
  • New individual plans must offer essential health benefits and no-cost preventive services. 
  • New individual plans cannot have lifetime and annual cost limits. There are also protections on how much you have to pay in out-of-pocket costs.

Applying for individual coverage

Health care reform has changed how and when you can apply for individual insurance.

  • Apply during open enrollment. Usually the only time you can apply for and enroll in a new individual plan is during the yearly open enrollment period.
  • You may be able to apply for a special enrollment at other times for certain qualifying events. This includes if you lost your health insurance through your job,got married, had baby, or had certain other important life or health coverage changes. You would have a limited time to enroll after a qualifying event.
  • Pay attention to application and premium payment dates! If you miss the deadlines, you likely won't be enrolled in a plan. You may lose the opportunity for health insurance until the next annual open enrollment period. And you may have to pay a tax penalty for not having health insurance.

Applying through Covered California

Individuals and small businesses can buy plans through Covered California, the state's health insurance marketplace. Visit www.coveredca.com or call 1-800-300-1506 for more information.

  • You can apply during Covered California's open enrollment period each Fall. You can apply anytime of the year for Medi-Cal or if you qualify for a Covered California special enrollment period.
  • You may qualify for tax credits to lower the cost of your monthly premium. Covered California is the only place you can use these tax credits.
  • Your premium costs are determined by the health plan you choose, your age, where you live, your income, and the size of your family. Covered California does not consider your health status or pre-existing conditions.

Applying to an insurance company or health plan

You can buy an individual plan directly from an insurance company or health plan, or through an insurance agent or broker. 

  • Insurance companies and health plans can no longer deny you or charge you more because of a pre-existing condition, such as diabetes or heart disease.
  • You can apply during the annual open enrollment period. You can also apply during a special enrollment period after a qualifying event.
  • Insurance companies that sell Covered California plans also offer similar plans outside of Covered California.  However, you cannot use tax credits for plans outside of Covered California.

Know your rights

There are laws that protect your right to buy individual insurance. There are also laws to prevent certain kinds of discrimination when you buy individual insurance. Learn more about your rights to get individual insurance.

Health Plan Problems?

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