These plans offer various coverage options, ranging from basic plans that cover essential medical services to more comprehensive plans that include additional benefits like prescription drug coverage, maternity care, mental health services, and preventive care.

In the United States, individual and family health insurance plans are generally offered during specific enrollment periods, which are typically open annually or during special circumstances, such as when someone experiences a qualifying life event (e.g., marriage, birth of a child, loss of other coverage).

Premiums are the monthly fees individuals or families pay to maintain their health insurance coverage. Additionally, these plans may involve cost-sharing arrangements, such as deductibles, co-payments, and coinsurance, where the insured person pays a portion of the medical expenses out of pocket.

Many individual and family health plans are structured around a network of healthcare providers. Insured individuals can generally receive more affordable care from in-network providers, and some plans may not cover services provided by out-of-network providers except in emergencies.

Under the Affordable Care Act (ACA), individual and family health plans offered through the Health Insurance Marketplace must cover essential health benefits, which include services like outpatient care, hospitalization, prescription drugs, preventive services, and more. Plans sold outside the Marketplace may have varying levels of coverage.

Health insurers offering individual and family plans typically cannot deny coverage or charge higher premiums based on an applicant’s health status or pre-existing conditions due to ACA regulations.

For individuals and families with low to moderate incomes, financial assistance in the form of premium tax credits and cost-sharing reductions may be available through the Health Insurance Marketplace to help make coverage more affordable.