Individual Coverage

Individual overview section

Effective January 2014, all citizens of the United States will be required by law to purchase health insurance ON or OFF the Exchange or be subject to the Individual Mandate Penalty.

The federal government (HealthCare.gov) and some states such as New York have set-up online exchanges, where you may go to purchase a medical insurance policy directly with the carrier. Some refer to the exchanges as the Marketplace. (The plans offered to individuals are not group rated plans). It is important to note that individuals and their families are not eligible for government assistance (premium tax credit or cost sharing subsidy) when the employer offers affordable employee-only coverage of a minimum value.

  • Q: What is the Health Insurance Marketplace?
  • A: The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.

  • Q: Can I save money on my Health Insurance Premiums in the Marketplace?
  • A: You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

  • Q: Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
  • A: Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards.

  • Q: What are These "Certain Standards?"
  • A: If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your individual annual W-2 income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. [Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.]

  • Q: Is My Employer required to continue my employee contribution if I decide to go on the exchange instead of the group plan?
  • A: No, but if they decide to the contributions will be taxable to you and included in your year end W-2.

  • Q: Are the individual rates for the carriers the same if I purchase an individual plan ON or Off the Marketplace?
  • A: Yes, but carriers are offering more plan options off the exchange.