Individual Medical Plans

There are a variety of options in the Individual market. These include ACA plans, Direct coverage with a carrier, short term medical and ACA qualified individual plans.

These different methods of providing insurance have their own special niches:

By going to Healthcare.gov in Florida and Georgiaaccess.gov in Georgia, major medical plans will be offered by a limited number of different carriers in 2026. These plans provide subsidies to those below a certain income level, which reduces the cost of the coverage. With changes coming from the federal government, these subsidies may be going away. However, the advantage of these plans is that they must take whoever enrolls, regardless of any health condition. This means that the cost of the plans is higher than similar plans found through private insurers. Further, while the coverage may be very similar to other plans, the access to doctors can be limited, either by access to doctors or access to appointments at doctors’ offices. This can mean a long wait time to see a provider. Lastly, you can only enroll in an ACA plan during open enrollment, Oct-Dec, unless you have a qualifying event such as loss of other health coverage. 

The Affordable Care Act requires major medical plans to include certain minimal essential benefits such as preventive care visits, mental illness, maternity and drugs which drive up the cost of these plans. If you choose only the benefits you deem as essential, the cost can be significantly lower.  Coverage for catastrophic events such as critical illnesses like cancer or accidents is where you are exposed to the greatest risk. When self-paying for the everyday medical expenses such as doctor visits, a blood test or medications, the cost versus submitting these claims through the insurance provider is much less.

The ACA plans are your safety net if your out of pocket medical expenses become excessive. We can direct you to direct pay resources such as GoodRX for drugs and direct primary care or concierge doctors in our area who prefer not to deal with insurance companies. Such providers include MedMutual, US Health Advisors, Philadelphia Life/ Freedom life. 

These plans are not insurance but generally non profit, faith based Healthcare Sharing Ministries where the member is solely responsible for the payment of his or her own medical bills with no guarantee for the payment of a Member’s medical bill.

They are a lower cost option to real insurance. The most popular being Medi-Share and Christian  Healthshare Ministries.

Some carriers, like BCBS, offer individual plans to the public. This can be obtained by going directly to the carrier site and signing up. These plans may be unaffordable as they are generally HMO plans and are priced to make sure the carrier is not losing money. The carrier cannot ask health questions, and you cannot be turned down. But, you can only enroll during open enrollment, Oct-Dec, or if you have a qualifying event. 

Different carriers offer participants coverage to fill a gap between coverages. This would happen if your COBRA runs out and you need something to get you through your waiting period at your new job. These plans run for a max of 4 months, then you have to change carriers and enroll in a new plan. You cannot go back to your starting carrier until you have completed 8 months at other carriers. This is due to government regulations. The carriers can ask health questions and they can deny coverage. Some

participants use these carriers because it is less expensive than direct coverage or ACA coverage and it protects the participant from catastrophic loss in the event of something major happening. It covers most things that a major medical plan covers, but there can be limitations. These plans are NOT ACA compliant, or to be used as a long term solution. There are a variety of carriers that offer these plans thru brokers, UHC, Aetna, Pivot to name a few. 

Recently,  these plans are provided by nationwide employers to individuals, sole proprietors, 1099 workers, etc. The provider hires the participant and will generate a w-2 for the participant at year end. The amount on the w-2 will equal the premiums paid into the plan, so it is a zero event in terms of taxes. In return for this coverage the participant agrees to complete surveys when asked. These surveys are to

gather information on health care usage. The benefits are that the plans are completely ACA compliant, national networks available on all plans, traditional plan designs, are all PPO plans and are affordable. Such plans have recently been provided by 1099 Workers and America’s Choice.