Understanding individual health insurance

In 2022, just over 92% of the US population — roughly 304 million individuals — had health insurance. And that was up 4 million more than the previous year. However, despite this progress, approximately 25 million Americans remain without health insurance coverage.

The good news is that the number of people without health insurance continues to decline primarily due to the expansion of coverage under the Affordable Care Act (ACA). Reports from early 2023 noted that over 40 million Americans were covered under the ACA, representing nearly 12% of the US population at the time.

Healthcare in the USA is indeed notoriously expensive, but making health insurance more affordable will make a big difference for many people, especially those who work for themselves, are between jobs, or don’t get benefits from an employer.

If you are in one of these situations and want to provide yourself and your family with good healthcare without breaking the bank, keep reading. We’ve written this blog to help you decide whether individual healthcare coverage is right for you.

What is individual health insurance?

Think of it as car insurance for your health. Individual health insurance is essentially a safety net that can be purchased independently to protect you and your family from emergency medical expenses and routine healthcare needs. This can include medical treatments, doctor visits, hospital stays, prescription medications, and other healthcare services. 

Unlike group health insurance, which is often provided as a benefit by employers, individual health insurance is something you buy directly from an insurance provider. This means you’re in charge of selecting and purchasing the coverage that best suits your needs and those of your family members.

And just like car insurance, you pay a monthly premium to the insurance provider. By doing so, you’re essentially investing in your healthcare needs — which, hopefully, will provide a sense of security and peace of mind.

What does it cover? Individual health insurance plans offer comprehensive coverage, spanning a wide range of healthcare services. Whether it’s a routine check-up, a specialist consultation, or emergency medical care, these plans aim to ease the financial burden of accessing necessary healthcare services. Additionally, they often extend coverage beyond basic medical treatments to include preventive care, diagnostic tests, mental health services, maternity care, and more.

How does individual health insurance work?

Individual health insurance operates on a simple principle: sharing risks. Your monthly premiums are pooled together with those from other policyholders to form a collective fund from which healthcare costs are covered. This approach spreads the financial risk across a larger group, easing the burden of expensive medical treatments or services on any single policyholder.

The actual dollar amount of your monthly premium is influenced by your age, health status, location, and the level of coverage you choose. In return, the insurance provider commits to covering a portion of your medical expenses as outlined in the policy. This could be for hospital visits, doctor consultations, prescription medications, preventive care, diagnostic tests, and/or rehabilitation services. Coverage may vary depending on your chosen plan, with some policies providing more extensive benefits than others.

In addition to monthly premiums, individual health insurance policies often include cost-sharing terms so that you, the insured, have some skin in the game. These may come in the form of deductibles, co-payments, and co-insurance. 

  • Deductibles require paying a predetermined amount out of pocket before insurance coverage kicks in. Once met, the insurance provider typically covers a percentage of the remaining healthcare costs. At the same time, you’re responsible for the rest through co-payments or co-insurance.
  • Co-payments are fixed fees you pay when receiving medical services, such as visiting a doctor or filling a prescription. These fees are usually standardized amounts set by the insurance provider and are intended to help offset the overall cost of care.
  • Co-insurance is a percentage of total healthcare costs you must pay after meeting the deductible. For example, if a policy has a co-insurance rate of 20%, the policyholder would be responsible for paying 20% of the healthcare costs while the insurance provider covers the remaining 80%.

These structures are in place to balance affordability for policyholders with sustainability for insurance providers. They help ensure that everyone has access to essential healthcare services while encouraging responsible use of coverage to keep premiums manageable for all.

Why choose individual health insurance?

Here are some key reasons why getting individual health insurance may be right for you.

You can customize your plan!

One of the key advantages of individual health insurance is its flexibility. Unlike group plans, which may have limited options or be subject to the decisions of an employer, individual health insurance allows you to customize coverage to align with your specific medical conditions, prescription drug requirements, and healthcare preferences. This might include coverage options like alternative therapies, gym memberships, telemedicine services — whatever coverage you need, without paying for unnecessary services or benefits.

Plans are portable!

Since individual health insurance plans are not tied to any specific jobs, you can keep your coverage regardless of changes in employment status. This portability aspect gives you the freedom to pursue career opportunities, transition to self-employment, or go through periods of unemployment — all without worrying about losing healthcare coverage.

You have a choice of providers!

Unlike certain managed care plans that limit access to a network of providers, individual health insurance often allows you to seek care from any licensed healthcare professional without needing referrals or approval. That means you’re free to pick your primary care physicians, specialists, hospitals, and other medical facilities. By building relationships with healthcare providers you trust and accessing the medical services you need, your overall satisfaction and quality of care are sure to improve.

Still without healthcare insurance? You don’t need to be. 

At the start of this article, we mentioned that more than 25 million Americans don’t have health insurance. However, individual health insurance is helping to bridge the gap for people without coverage, and that number is going down. This is good news for freelancers, part-time workers, students, and others who might not qualify for group coverage through conventional employment.

Choosing individual health insurance gives you the freedom to get personalized coverage, tailor it to fit your budget and ensure it meets your needs — whatever those may be. 

At Guided Solutions, we’re here to help you find the perfect individual health insurance. We’ll discuss your situation, explore the options, and handle all the necessary research to uncover the best plans that align with your needs and budget.

Whether you want to kick things off with an online quote or prefer to chat over the phone, we’re here to guide you through the intricacies of health insurance seamlessly.


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