Individual and Family Health Insurance: A Practical Guide

What counts as an individual or family plan?

An individual plan covers one person. A family plan covers two or more people — a spouse, children, or both — usually on one policy with a shared deductible and out-of-pocket maximum. Some families save by splitting adults and children across different plans, which an agent can price for you.

How is a family plan priced?

Under the ACA, premiums are based on the age of each adult on the policy, your location, tobacco use and the plan you choose. Children are typically priced differently than adults.

[VERIFY: current premium range for a family of four in your market, including how much a subsidy lowers it.]

• Each adult on the policy can raise the monthly premium
• A subsidy is based on household income and size, not per person
• Deductibles and out-of-pocket maximums are often shared
• Adding a newborn usually requires updating the policy within a set window

ACA, private or supplemental for your family?

Most families start by pricing ACA Marketplace plans because they must accept everyone and can include subsidies. Private plans and supplemental products like dental, vision, accident or critical-illness coverage can fill specific gaps, but they are not a substitute for major medical coverage.

Covering children and dependents

Children can generally stay on a parent's plan until they turn 26, and the Children's Health Insurance Program (CHIP) or Medicaid may cover kids at a lower cost if household income qualifies. An agent can check both against your Marketplace options.

What to check before you enroll your family

Confirm the doctors your family already uses, the prescriptions each person takes and the hospitals nearest you. Then compare the plan's total annual cost — premiums plus the out-of-pocket maximum — rather than shopping on premium alone.