What to know about Individual & Family Plans

Finding the right health care coverage for your needs may be confusing. You might have heard about health insurance through the exchanges, also known as health care marketplaces, but perhaps like many other uninsured Americans, you assumed coverage would be too expensive. 

A young woman wearing headphones reads a computer screen A young woman wearing headphones reads a computer screen

The fact is, millions of Americans remain uninsured, despite qualifying for assistance — and there are more coverage options than ever before. To help explain what these plans could mean for you and your family, Marcus Robinson, senior vice president of sales for Individual & Family Plans at UnitedHealthcare, answers a few questions about these types of plans and how to enroll in them.

How does the Inflation Reduction Act change the health care marketplace?

A couple of things. First, subsidies have been extended through 2025 and many consumers are now eligible for coverage with a $0 premium or for lower premiums depending on their income. For a long time, subsidies were unavailable to individuals with incomes at or above 400% of the federal poverty level. Through 2025 that “subsidy cliff” has been removed, and instead individuals’ contribution towards premiums is capped at no more than 8.5% of their income, with subsidies available to cover the rest.

Can you explain what the exchanges are?

The health care exchanges on healthcare.gov or certain state-based sites (sometimes referred to as the marketplace) provide access to shop and enroll in health plans for individuals and families. Depending on the state, the exchange might be run by the federal government, the state itself, or a combination of the two.

Plans on the exchange have tiers such as gold, silver and bronze. Can you break down the difference between the “metallic” levels?

The “metal” level indicates the richness of the insurance coverage. For example, the bronze level is going to have the most cost-effective plans — lower premiums, but higher out-of-pocket costs (such as deductibles, coinsurance or copayments) when a member seeks care. The gold level, on the other hand has higher premiums but lower out-of-pocket costs.

Which levels of plans do the subsidies apply to?

You get to choose. Once you have qualified for a subsidy amount, you can take that subsidy and shop for any type of plan design you choose. For example, you could use your subsidy with a bronze or silver plan and potentially have a plan with zero premium depending on your income level. In addition to the premium subsidies described above, some individuals may also qualify for another form of subsidy called Cost-Sharing Reductions (“CSRs”) depending on their income. These CSRs help reduce the amount that an individual has to pay out-of-pocket toward deductibles, coinsurance, and copayments. It is important to note that CSRs are only available on plans at the silver metallic level. 

What do you recommend for those who might be new to this? 

Health care is personal. You want to look at how frequently you use health care, what medications you take and what the cost of them might be — and keep that in mind while shopping. You also might want to look at what physicians and hospitals are in network. Many plans may offer virtual visits at no additional cost or offer wellness and value-added benefits. Highlights of some Individual & Family plans with UnitedHealthcare may include:1

  • $0 unlimited primary and virtual urgent care visits2
  • Prescriptions as low as $3 at Optum Rx Home Delivery
  • Tier 1 drugs for as low as $3 at Walgreens and 20% off Walgreens-brand health and wellness products3
  • Dental and vision coverage for adults4
  • Complimentary access to digital fitness classes5

You can always learn more at UHCExchange.com (in Spanish at uhcexchange.com/es) or contact 1-877-649-9797 to get help with finding the best plan for you.

When can people shop for a plan? Is there a specific enrollment period?

In most states, open enrollment will end Jan. 15, 2023. If you want your coverage active on Jan. 1, 2023, make sure that you enroll by Dec. 15, 2023. Enrollments completed between Dec. 16 and Jan. 15 will have coverage effective Feb. 1, 2023.

How do you enroll in a plan? What if someone has barriers to access a computer?

You can learn more about this type of coverage at UHCExchange.com (in Spanish at uhcexchange.com/es) or you can call 877-649-9797 to speak with enrollment specialists about the plans UnitedHealthcare offers in your area.

Most areas have navigators and assistors available in multiple languages or you can find licensed agents at Health Markets, who can help people enroll in all types of plans.

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[1] The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more.

[2] Virtual visits conducted by telephone or video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider.  Data rates may apply.  Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members, and visit limits may apply. Check your benefit plan to determine if these services are available.

[3] Walgreens discount valid until 12/31/23. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the United Healthcare discount program. Discount cannot be used online. For full list of Walgreens brand health and wellness products, please visit www.walgreens.com/Smartsavings.  Offer not available on the following items: photo orders, prescriptions, tobacco, dairy, alcohol, liquor departments, phone/prepaid/gift cards, money orders/transfers, transportation passes, lottery tickets, charitable donations, pseudoephedrine or ephedrine products, newspapers, magazines, stamps, home medical equipment and durable medical equipment products, pharmacy items and services, Prescriptions Savings Club membership fee, and items or services submitted to insurance for reimbursement or where otherwise limited by law.  Walgreens reserves the right to discontinue the offer at its discretion.

[4] $0 cost-share for in-network periodic oral evaluation 2 times per consecutive 12 months, coverage is limited to a $1,000 benefit maximum. Routine vision exam and eyewear are limited to once every 12 months. If you opt to receive vision care services or vision care materials that are not covered benefits under this plan, a participating vision care provider may charge you their normal fee for such services or materials. Coverage may not be available in all plans or in all states. For costs and complete details of coverage, contact your broker or the company.

[5] The Peloton offering is available to members enrolled in applicable fully insured UnitedHealthcare plans and participants enrolled in UnitedHealthcare Level Funded NavigateNOW plans who are 18+ years of age and register for an account with Peloton. Offer is valid until June 30, 2023. UnitedHealthcare members and participants that own a Peloton Bike, Bike+ or Tread can redeem a 3-month All-Access Membership. Limit one code redemption per UnitedHealthcare member or participant. All services provided by Peloton directly to consumers are governed by Peloton’s Membership Terms, located at https://www.onepeloton.com/membershipterms. Discounts available on applicable purchases until June 30, 2023. Equipment offer void in Maryland, New York, New Jersey, Pennsylvania, or Washington D.C. To inquire about eligibility for a retroactive refund on applicable purchases, contact Peloton customer service. Peloton Bike, Bike+ or Tread purchase requires an All-Access Membership to access content. All prices are exclusive of applicable taxes. Offer applied at checkout. No substitutions. Peloton equipment discount is limited to a purchase of one unit of each equipment type per member or participant. Void where prohibited. Not transferable. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. UnitedHealthcare members and participants should consult with an appropriate health care professional before beginning any exercise program and/or to determine what may be right for them. The value of this offering may be taxable. Members and participants should consult with an appropriate tax professional to determine if they have any tax obligations from having access to this offering at no additional cost.