Most people have never bought coverage for themselves and assume it must be complicated. It isn’t. There are four or five real routes, and one of them is yours.
If you don’t get health insurance through an employer, you buy it yourself as an individual — and there are five routes. The ACA Marketplace, where you may qualify for a premium tax credit. A private plan bought directly from a carrier. COBRA, if you’re coming off a job plan. Medicaid or CHIP, if your income is low enough and your state’s rules allow it. Or a parent’s plan, if you’re under 26. Everything below is how to tell which one is yours.
This page is for anyone without a job plan, for any reason: you work part-time, you’re a contractor, your employer simply doesn’t offer coverage, you retired before 65, you’re a spouse who was left off a plan, or the plan at work exists but costs more than you can pay. Those situations have different answers, so each one gets routed to the right place further down.
This is the default for most people, and for good reason. Marketplace plans are guaranteed issue — you cannot be turned down, charged more, or have a condition excluded because of your health history. Every plan covers the ten essential health benefits. And if your income qualifies, a premium tax credit is applied directly to your monthly premium rather than waiting until you file taxes.
The tradeoffs are real. On-exchange menus in many markets are dominated by narrow HMO networks, and if your income lands above the subsidy line, you pay full retail for a plan built around a subsidy you’re not getting.
Bought directly from a carrier, available year-round, no enrollment window. These frequently carry a broader PPO network and a lower premium than an unsubsidized Marketplace plan, which makes them worth a look for a healthy household above the subsidy line.
Be clear-eyed about what they are. They’re medically underwritten — the application asks about your health history, and coverage can be declined, limited, or priced based on it. They’re not ACA-compliant, so pre-existing conditions may be excluded and the essential health benefits guaranteed on every Marketplace plan aren’t automatic here. Term lengths and renewal rules vary by plan and by state.
If you have an ongoing condition, the guaranteed coverage of an ACA plan is usually worth more than the premium difference, and I’ll tell you that rather than sell around it. What each plan type actually covers goes through this in more detail.
Only relevant if you’re coming off an employer plan. You keep the exact plan, network, doctors, and any deductible you’ve already met — but you pay the entire premium your employer was mostly covering, plus an administrative fee. It’s the right answer more often than its reputation suggests, and almost never on price alone. The full comparison lives on the between-jobs page, along with the 60-day clock that starts the day your coverage ends.
Income-based and administered by your state, which is why the answer changes at the state line. Children often qualify through CHIP at household incomes well above the adult threshold, so a family can land in a split situation where the kids are covered through CHIP and the parents buy a Marketplace plan.
Florida is one of ten states that has not expanded Medicaid. Parents qualify only at roughly 27% of the federal poverty level, and adults without dependent children generally don’t qualify at any income. That produces the coverage gap: earning too little for a Marketplace subsidy, which starts at 100% of the federal poverty level, and too much for Medicaid. If you’re in Florida and in that gap, say so on the call — the options are narrower and I’d rather tell you that plainly than waste your afternoon.
You can stay on a parent’s plan until you turn 26 regardless of whether you live with them, are married, are financially independent, or have a job that offers coverage. Turning 26 is itself a qualifying event, which opens a special enrollment period. If that’s coming up, start looking about two months out rather than the week it happens.
Individual coverage runs on a calendar, and missing it is the single most common expensive mistake people make here.
Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 in most states. Enroll by December 15 and coverage starts January 1. Enroll between December 16 and January 15 and coverage generally starts February 1 — meaning you carry January uninsured. A few state exchanges run their own dates: Idaho opens October 15, Connecticut and Massachusetts open October 23.
Outside that window you need a qualifying life event, which opens a 60-day special enrollment period. The common ones: losing other coverage, moving to a new area, marriage or divorce, the birth or adoption of a child, and turning 26. Private non-Marketplace plans are the exception — they’re sold year-round, which is part of why they come up when someone misses the window.
The honest version: an individual plan often looks more expensive than a job plan because at a job, someone else was paying most of it. The subsidy is what closes that gap, and for 2027 it has a hard edge.
The enhanced subsidies that ran from 2021 through 2025 have expired. For 2027, the 400% subsidy cliff is back. Premium tax credits apply between 100% and 400% of the federal poverty level, and above that line the credit is zero — not reduced, zero. Based on the 2026 federal poverty guidelines, which govern 2027 coverage, the top of that range is:
A dollar over, and the credit disappears entirely. That makes income projection genuinely consequential rather than a formality, especially if you’re self-employed and have some control over the timing of income and deductions. If you expect to land above the line, the no-subsidy page covers what’s worth doing instead.
This is the case most people get wrong, because the usual assumption is that any offer of employer coverage locks you out of help. It doesn’t.
There’s an affordability test. For the 2027 plan year, employer coverage counts as affordable if your required contribution for the lowest-cost self-only plan that meets minimum value is no more than 10.22% of household income — set by IRS Revenue Procedure 2026-26, and the highest that figure has ever been. If your share exceeds it, the offer is deemed unaffordable and you may be eligible for a Marketplace premium tax credit instead.
There’s a second part that matters more for families. The test for your spouse and children uses the cost of family coverage, not self-only coverage — the 2022 rule change known as the family glitch fix. That distinction is often the whole ballgame: an employer plan can be entirely affordable for the employee and well over the line for the family, in which case the employee stays on the job plan and the rest of the household may qualify for subsidized Marketplace coverage.
Plenty of households are in that position and have never run the numbers. It takes about five minutes with your benefits paperwork. Bring the self-only contribution and the family contribution and I’ll walk the math with you — I won’t tell you what you’ll qualify for, because that’s a determination the Marketplace makes, but you’ll know where you stand before you apply.
The routes above apply to everyone. These pages go deeper on specific situations:
Nothing. Not a fee, not a markup, not a “consultation charge.” Brokers are paid a commission by the insurance carrier, and that commission is built into the premium whether you use a broker or not. Enroll directly and the carrier keeps it. Enroll through me and it pays for someone who works on your behalf and picks up the phone in March when something goes wrong.
The plan costs the same either way. I’d rather you know exactly how I’m paid than wonder. There’s a fuller explanation on the licensing page, along with my NPN so you can verify I am who I say I am.
You buy it yourself as an individual. The main routes are the ACA Marketplace, where you may qualify for a premium tax credit based on your projected annual income; a private, medically underwritten plan purchased directly from a carrier; Medicaid or CHIP if your household income is low enough and your state’s rules allow it; or a parent’s plan if you are under 26. Which one fits depends on your income, your health, and your state.
Yes. Individual health insurance is available in every state and does not require an employer. ACA Marketplace plans are guaranteed issue, meaning you cannot be turned down or charged more for a pre-existing condition, and they can be purchased during Open Enrollment or a special enrollment period. Private non-Marketplace plans are sold year-round but are medically underwritten.
Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 in most states. Enroll by December 15, 2026 for coverage starting January 1, 2027; enroll between December 16 and January 15 and coverage generally starts February 1. Outside that window you need a qualifying life event, such as losing other coverage, moving, marriage, or the birth of a child, which opens a 60-day special enrollment period.
For the 2027 plan year, employer coverage is considered affordable if the employee’s required contribution for the lowest-cost self-only plan that meets minimum value is no more than 10.22% of household income, under IRS Revenue Procedure 2026-26. For family members, the test uses the cost of family coverage rather than self-only coverage. If the coverage offered to you fails that test, you may be eligible for a Marketplace premium tax credit instead. The calculation depends on your specific numbers and is worth checking rather than assuming.
Often, but not always. An employer typically pays a large share of the premium, so the sticker price of an individual plan can look higher. Marketplace premium tax credits offset that for households under 400% of the federal poverty level. For 2027 that line is $63,840 for one person and $132,000 for a household of four, and above it the credit is zero rather than reduced.
Licensed in 31 states as Rohr Health Advisors LLC — Cavin Rohr, NPN 21388659. You can verify that before you call me, and I’d encourage it.
Tell me your state and roughly what you expect to earn this year. Those two things decide most of it.
No fee, no pressure, no obligation to enroll in anything.
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