Health Insurance For Individuals

Key features of ACA Marketplace plans:

• Essential Health Benefits: Preventive care, mental health, maternity, prescription drugs
• Pre-existing Condition Protections: No denials or higher rates based on health history
• Financial Assistance: Premium tax credits (100–400% FPL) and cost-sharing reductions (100–250% FPL)
• Metal Tiers:
  • Bronze: Lowest premiums, highest out-of-pocket costs
  • Silver: Moderate premiums, eligible for additional subsidies
  • Gold: Higher premiums, lower out-of-pocket costs
  • Platinum: Highest premiums, minimal cost-sharing

     

Cost considerations:

• Premiums: Monthly plan payments
• Deductibles: Amount you pay before coverage kicks in
• Copays & Coinsurance: Your share after meeting deductible

   

Enrollment periods:

• Open Enrollment: Nov 1–Dec 15 (dates vary by state)
• Special Enrollment Period (SEP): 60 days after losing other coverage for life events (job loss, marriage, move)

   

Turning 26

If you’re approaching age 26, Kalish Financial helps you transition smoothly off your parents’ plan and secure new coverage.

When does coverage end?

• On your 26th birthday, the last day of your birth month, or your plan’s year-end—confirm dates with your insurer

   

Your coverage options:

• Employer-Sponsored Plans: Often more affordable; check with HR for enrollment windows
• ACA Marketplace: Qualify for a 60-day SEP to enroll outside Open Enrollment
• Medicaid: If your income meets state thresholds
• Catastrophic Plans: Available under age 30 or via hardship exemption
• COBRA: Continue parent’s employer coverage up to 36 months (you pay full premium)

   

Enrollment deadlines:

• Special Enrollment Period: Begins when parental coverage ends (60 days)
• Open Enrollment: Nov 1–Dec 15 (state-specific)
• Employer Periods: Vary by employer—check your benefits portal

   

Choosing the right plan:

1. Assess Needs: Frequency of care, prescriptions, preferred doctors
2. Balance Costs: Compare premiums vs. deductibles and copays
3. Verify Networks & Benefits: Telehealth, wellness programs, mental health coverage