Health coverage, for individuals & families.

Health insurance helps people pay for medical care — from routine visits to major hospital stays — in exchange for a monthly premium. Here's how the individual and family market works.

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Overview

What health coverage is

Health insurance is a contract between a person and an insurance carrier: the member pays a monthly premium, and in return the plan covers a share of covered medical costs. Most plans share costs through a deductible, copays, and coinsurance, up to an annual out-of-pocket maximum that caps what a member can pay in a year.

In the individual and family market, coverage is bought directly rather than through an employer. Plans sold on the ACA marketplace (Healthcare.gov or a state exchange) are the only ones eligible for income-based premium subsidies, while off-exchange plans are bought directly from a carrier. Both must cover the ACA's essential health benefits. Shorter-term and supplemental products fill specific gaps but are not comprehensive major medical.

Coverage Types

The individual & family product shelf

ACA marketplace plans

On-exchange major medical in Bronze, Silver, Gold, and Platinum tiers. The only plans eligible for premium subsidies (APTC) based on household income.

Off-exchange major medical

Comprehensive coverage bought directly from a carrier, outside the exchange. Same essential benefits, but no marketplace subsidy.

Short-term medical

Temporary, lower-cost coverage that bridges a gap between plans. Not ACA-compliant and may exclude pre-existing conditions.

Supplemental & critical illness

Accident, hospital indemnity, and critical-illness plans that pay cash benefits alongside a primary plan.

Dental & vision

Standalone plans for routine dental and eye care not typically covered by major medical.

ICHRA & individual coverage

Individual plans an employee can pair with an employer reimbursement arrangement.

Who It's For

Common client profiles

Self-employed & gig workers

People without access to employer coverage who buy their own plan.

Early retirees

Adults who retire before 65 and need coverage until Medicare eligibility.

Families & dependents

Households shopping subsidy-eligible marketplace plans during open enrollment.

Between jobs

People needing a short-term bridge after losing group coverage.

Part-time & contract

Workers whose employer offers no benefits.

Supplement seekers

Members who want accident or critical-illness cash protection on top of a base plan.

Key Terms

Terms worth knowing

Premium: The fixed amount paid each month to keep coverage active.
Deductible: What a member pays out of pocket before the plan starts sharing most costs.
Copay: A flat fee for a specific service, like a doctor visit or prescription.
Coinsurance: The member's percentage share of a covered cost after the deductible.
Out-of-pocket maximum: The most a member pays in a year; the plan then covers 100% of covered costs.
Network (HMO/PPO/EPO): The doctors and facilities a plan contracts with; plan type sets referral and out-of-network rules.
Subsidy (APTC): An income-based tax credit that lowers marketplace premiums.
Open enrollment / SEP: The annual window to enroll, plus Special Enrollment Periods triggered by life events.

Common Questions

Health FAQ

When can someone enroll?

During the annual Open Enrollment Period, or a Special Enrollment Period triggered by a qualifying life event such as losing coverage, marriage, or a new child.

What decides a subsidy?

Household income relative to the federal poverty level, and whether affordable employer coverage is available. Subsidies apply only to marketplace plans.

HMO vs PPO?

HMOs use a set network and often require referrals; PPOs offer more out-of-network flexibility at a higher premium.

Is short-term the same as ACA coverage?

No. Short-term plans are cheaper but not ACA-compliant and can exclude pre-existing conditions — they suit brief gaps, not long-term needs.

Write health with one appointment

Unity First Nation contracts you across the carriers behind these products — with quoting, compliance, and back-office support.

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