Individual Health Plans

Al Crouse & Associates has been assisting customers for over 20 years in purchasing their own individual health insurance.

With the implementation of the Affordable Care Act (ACA), there have been multiple impacts on the individual health insurance market. Applicants can no-longer be turned down or rated up for Qualified Health Plan coverage options due to a pre-existing condition (other than tobacco use) as long as the applicant applies during the Open-Enrollment Period, or qualifies for a Special Enrollment Period. The Open Enrollment Period generally runs from November 1st to December 15th. Contact us to see if you may qualify for a Special Enrollment Period, such as loss of credible health insurance coverage in the last 60 days.

Applicants may qualify for a subsidy to help lower their monthly cost, officially known as an Advanced Premium Tax Credit, by purchasing a plan through the Federal Health Insurance Marketplace. These subsidies are based upon taxable household size and household Modified Adjusted Gross Income. Please see the guideline chart below. Please note, however, if an applicant has access to an employer based health plan (even through a spouse) that the IRS has determined to be adequate and affordable, or a governmental health plan such as Medicare or Medicaid, then the applicant may not qualify for a subsidy.

Applicants will not have a different rate for gender, and maternity coverage will be included in all plans along with other certain Essential Health Benefits.

A Qualified Health Plan has a metallic designation: Platinum, which covers approximately 90% of medical expenses. Gold, which covers approximately 80% of medical expenses. Silver, which covers approximately 70% of medical expenses. And finally Bronze, which covers approximately 60% of medical expenses. There will also be coverage available to certain enrollees for catastrophic coverage if the enrollees meet certain criteria. The Qualified Health Plans cannot have more than $9450 in-network out of pocket maximum for an individual and $18,900 for a family in 2024 excluding monthly premiums.

Request For Information And Application Submission Guidance

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To be eligible for a federal subsidy, your income based upon household size must be above 138% of the Federal Poverty Level. Households earning above 400% may qualify for a federal subsidy if the insurance premiums exceed 8.5% of household income and among other criteria.

Household Size 139% 150% 250% 400%
1 $20,266 $21,870 $36,450 $58,320
2 $27,411 $29,580 $49,300 $78,880
3 $34,555 $37,290 $62,150 $99,440
4 $41,700 $45,000 $75,000 $120,000
5 $48,845 $52,710 $87,850 $140,560
6 $55,989 $60,420 $100,700 $161,120
7 $63,134 $68,130 $113,550 $181,680
8 $70,278 $75,840 $126,400 $202,240

In December of 2023, NC implemented Medicaid Expansion for Households earning below 138% of the Federal Poverty Level. Contact your local Department of Social Services for more information.