Individual & Family Health Insurance

Individual and family health insurance, made clear.

ACA major medical coverage for you and your family. A licensed Plansure broker compares the plans in your area, checks your doctors and prescriptions, and reviews whether you qualify for financial help.

Or call a Plansure broker at (817) 632-5155

Individual and family health insurance is ACA major medical coverage you buy on your own, instead of getting it through an employer. It covers the essential health benefits, always covers pre-existing conditions, and many people qualify for financial help based on their income. Here is who it fits and how getting covered works.

Carrier names and logos are the property of their respective owners. Plansure is an independent broker, not a carrier.

Who it's for

Who individual and family coverage is for.

If you do not get health insurance through a job, an individual or family plan is built for you.

Self-employed or 1099

You work for yourself and don't have an employer plan. Major medical covers you the same way a job-based plan would.

Families without employer coverage

Your job doesn't offer benefits, or covering the family through work costs more than buying your own plan.

Early retirees under 65

You retired before Medicare starts and need real coverage to bridge the years until you turn 65.

Between jobs or COBRA is too expensive

You lost employer coverage and COBRA costs more than a marketplace plan. Losing a job opens a Special Enrollment window.

How it works

How getting covered works.

Four steps, one licensed broker, no marketplace runaround. You can enroll during Open Enrollment, or any time a life event opens a Special Enrollment window.

Step 1

Share your ZIP

Tell us where you live and who needs coverage. Plans and prices are set by your county, so the ZIP comes first.

Step 2

A broker compares your area

A licensed Plansure broker compares the plans available where you live, instead of pointing you at one carrier.

Step 3

Check your doctors and Rx

We check each plan's network against the doctors you see and the prescriptions you take before you pick one.

Step 4

Enroll and get covered

Once you enroll, ACA coverage can start the 1st of the next month. Enrollment timing follows the windows below.

What it covers

What a major medical plan covers.

Every ACA major medical plan covers the ten essential health benefits. The networks and drug lists differ by plan, but these categories are always included.

Essential health benefits covered on an ACA major medical plan
Benefit	Covered on an ACA major medical plan
Preventive care (checkups, screenings, vaccines)	In-network preventive care at no extra cost
Doctor and specialist visits	Covered
Hospital and inpatient care	Covered
Emergency services	Covered
Prescription drugs	Covered per the plan's drug list
Maternity and newborn care	Covered
Mental health and substance use	Covered
Pediatric services	Covered, including pediatric dental and vision

Pre-existing conditions are always covered on ACA major medical plans. Actual coverage, networks, and drug lists vary by plan and by area. A Plansure broker reviews the specifics with you.

Metal tiers

Understanding metal tiers.

ACA plans are grouped into four metal tiers. The tier is about how you split costs with the plan, not about quality of care. A higher tier means a higher monthly premium and less you pay when you use care.

Bronze

Smaller monthly premium, higher out-of-pocket

You pay less each month and more when you use care. Often a fit if you're healthy and mainly want protection from a large, unexpected bill.

Silver

Balanced premium and out-of-pocket

A middle-ground plan. Silver is also where cost-sharing reductions can apply, which can lower what you pay for care if your income qualifies.

Gold

Higher monthly premium, lower out-of-pocket

You pay more each month and less when you use care. Often a fit if you see doctors regularly or take ongoing prescriptions.

Platinum

Richest coverage, highest monthly premium

The most coverage when you use care, with the highest premium. A fit for people who expect heavy, ongoing medical use. Not offered in every area.

Financial help

Could you qualify for financial help?

You may qualify for financial help, called a subsidy, that can lower what you pay for an ACA marketplace plan. Whether you qualify depends on your income and your household size. There is no income you need to memorize and no form you need to figure out on your own.

It is based on income and household

Eligibility is tied to your projected household income and how many people are in your household.

A broker checks your eligibility

A licensed Plansure broker reviews your eligibility for financial help before you enroll. No guessing.

You see the real picture first

We walk through your options and what applies to your situation, so you enroll knowing what to expect.

Eligibility for financial help is determined by the marketplace based on your income and household size. Plansure does not guarantee any subsidy amount or savings. A licensed broker reviews your eligibility before you enroll.

Individual & family FAQs

Questions most clients ask.

When can I enroll?

ACA plans have an annual Open Enrollment window. Outside of that window, you need a Special Enrollment Period, which a qualifying life event opens. Losing other coverage, moving, getting married, having a baby, or losing a job each open a 60-day window to enroll. A Plansure broker confirms which window applies to you.

What is a subsidy and do I qualify?

A subsidy is financial help that can lower what you pay for an ACA marketplace plan. You may qualify for financial help based on your income and household size. A licensed Plansure broker checks your eligibility using your projected household income before you enroll. We do not quote a dollar amount until your eligibility is reviewed.

What does an individual or family plan cover?

ACA major medical plans cover the ten essential health benefits, including preventive care, doctor visits, hospital and emergency care, prescriptions, maternity, mental health, and pediatric services. Pre-existing conditions are always covered. The exact networks and drug lists vary by plan, and we review those with you.

Can I keep my doctor?

Often, yes. Before you enroll, a Plansure broker checks each plan's provider network against the doctors you already see. If a doctor is not in-network on one plan, we tell you which plan keeps them in so there is no surprise after you enroll.

How is this different from short-term coverage?

An individual or family plan is ACA major medical. It covers the essential health benefits, always covers pre-existing conditions, and can qualify for financial help. Short-term coverage is temporary, covers fewer benefits, may exclude pre-existing conditions, and does not qualify for a subsidy. We explain both so you can compare honestly.

Can I add dental and vision?

Yes. Many family plans include pediatric dental and vision, and adults can add standalone dental and vision coverage alongside a medical plan. A Plansure broker can quote those together so you see the full picture.

Find a plan your family can be sure about.

Share your ZIP and a licensed Plansure broker compares the plans in your area, checks your doctors and prescriptions, and reviews whether you qualify for financial help.

See plans in my area (817) 632-5155

Plansure Insurance is a licensed independent insurance brokerage. We are not affiliated with HealthCare.gov, Medicare, or any government agency.

Carrier names and logos are the property of their respective owners. Plansure is an independent broker, not a carrier. Eligibility for financial help is based on your income and household size and is determined by the marketplace.