Are you looking for health insurance for yourself or your family?
If so, chances are it’s for one of the following reasons:
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It’s Open Enrollment time, you’ve received a renewal offer, and you want to see what else is available — maybe you’re looking for better benefits, a lower monthly premium, or a larger provider network.
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You’re losing your employer-based health insurance and need to explore your coverage options.
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You’ve had a life event like marriage, adoption, or the birth of a child.
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You’ve moved to a new area and need to choose a new plan.
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Your health or income has recently changed, and it’s time to re-evaluate your health coverage.
There are plenty of other reasons, of course, but these are the most common. On this page, we’ll walk you through what you need to know about individual and family health insurance coverage. We’ll explain the types of health plans, the financial assistance that may be available, and the options to consider based on your specific situation.
Have questions or need help picking a plan?
Give us a call at 972.245.0266 or email us at info@jmeinsurance.com — we’re happy to help.
What Are My Insurance Options?
If you need health coverage, an individual Marketplace plan (possibly with a subsidy) might be the best choice — but it’s certainly not the only option. Depending on your situation, there are several paths to getting the coverage you need:
Marketplace Plans (Healthcare.gov)
If you qualify for financial assistance, purchasing a plan through the federal Marketplace can significantly lower your monthly premium and out-of-pocket costs. Most Americans are eligible for some type of subsidy.
📅 Marketplace plans are only available during the Open Enrollment Period (November 1 – January 15) or if you qualify for a Special Enrollment Period due to a life event.
Off-Exchange Plans
If you don’t qualify for a premium tax credit, you may have access to additional plan options offered outside the Marketplace. These “off-exchange” plans are ACA-compliant and often include different provider networks or plan designs.
📅 Off-exchange plans follow the same enrollment windows as Marketplace plans. You must apply during Open Enrollment or qualify for a Special Enrollment Period.
Special Enrollment Periods (SEP)
A Special Enrollment Period allows you to enroll in a Marketplace or off-exchange individual plan outside of Open Enrollment. You may qualify if you experience a major life event such as:
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Losing other health coverage
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Getting married or divorced
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Having a baby or adopting
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Moving to a new state or region
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Gaining lawful presence in the U.S.
SEPs usually provide a 60-day window to enroll from the date of your qualifying event.
Continuing Your Current Coverage
If you recently lost job-based coverage, you may be able to continue your existing plan:
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COBRA lets you stay on your former employer’s group health plan for up to 18 months (at full cost).
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Texas State Continuation offers shorter-term continuation for small group plans (typically 9 months).
Joining Other Group Coverage After Loss of Coverage
If you lose your current coverage, you may have the right to join your spouse’s or partner’s employer-sponsored health plan mid-year.
This is called a HIPAA Special Enrollment Right, and it provides a limited window (often 30–60 days) to enroll in other group coverage without waiting for that plan’s annual open enrollment.
Short-Term Health Coverage
Healthy individuals looking for temporary, lower-cost coverage may consider short-term plans. These plans are not ACA-compliant and generally don’t cover pre-existing conditions, maternity, or mental health care — but they can help bridge gaps between longer-term coverage.
Small Group Health Plans for Business Owners
If you own a small business or even a side business, you may be eligible to establish a small group health plan. Group plans can offer excellent benefits and greater flexibility — and they can start any month of the year, regardless of the individual Open Enrollment timeline.
Additional Alternatives
Other coverage paths may be available depending on your situation, including:
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Student health insurance plans (for college students)
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Supplemental or limited benefit plans (to help with unexpected costs)
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Health Care Sharing Ministries (faith-based cost-sharing arrangements that are not insurance)
Frequently Asked Questions
Most individual and family plans available through the ACA Marketplace are HMO-style plans. This means you’ll typically need to use in-network doctors and hospitals, and get a referral to see a specialist. PPOs, which offer more flexibility, are rarely available in the individual market. All ACA-compliant plans are required to cover essential health benefits, including preventive care, prescription drugs, emergency services, mental health, maternity, and more — but networks and plan details vary by carrier.
Yes! If you don’t have access to affordable employer coverage, you may qualify for a premium tax credit to reduce your monthly premium — and possibly cost-sharing reductions to lower deductibles and copays. These subsidies are based on your household size and estimated income for the year. Most people qualify for some form of assistance, and we can help you estimate your eligibility and apply through Healthcare.gov or your state’s Marketplace.
No. Plans sold through the ACA Marketplace are guaranteed issue, which means you cannot be denied coverage or charged more due to a pre-existing condition. There are no medical exams or health questionnaires required. You simply select the plan that works best for you — and your coverage begins as early as the first of the following month.
That depends on the insurance carrier’s provider network. Because most plans in the individual market are HMOs, they require you to see in-network providers for care to be covered (except in emergencies). Before enrolling, we’ll help you check whether your preferred doctors, hospitals, and specialists participate in the plan’s network so there are no surprises.
The Open Enrollment Period runs from November 1 through December 15 for a January 1 start date. During this time, anyone can sign up or switch plans. If you miss it, you may still be eligible for a Special Enrollment Period triggered by events like losing job-based coverage, moving to a new state, getting married, having a baby, or other qualifying life events. If you don’t qualify for a special enrollment window, you may need to consider a short-term plan until the next Open Enrollment Period.
To apply for Marketplace coverage and financial assistance, you’ll need basic information like names, birthdates, and Social Security numbers for everyone applying. You should also estimate your household income for the year — typically based on your adjusted gross income plus certain tax-exempt amounts. If you’re not a U.S. citizen, you may need to provide immigration documents. Having your most recent tax return or pay stubs nearby can make the process easier.
If you’re in between jobs or waiting for other coverage to begin, a short-term health plan may be a temporary option. These plans are not ACA-compliant and usually don’t cover pre-existing conditions, maternity, or mental health care — but they can help protect you in case of major illness or injury. Short-term plans are not guaranteed issue and may involve basic medical questions. They’re best used as a short-term solution when you don’t qualify for an ACA plan.
Dental and vision plans are not included in most health insurance plans for adults but can be purchased separately. Pediatric dental is sometimes included in ACA plans, but adult coverage must be added as a standalone plan. We can help you compare affordable options for dental and vision coverage that match your needs and budget.
No — there’s no additional cost to work with a licensed agent. Health insurance premiums are the same whether you enroll directly or with help. The advantage of working with an agent is getting personal guidance, access to plan comparisons, and ongoing support throughout the year — including help resolving billing or coverage issues, and guidance during future renewals or life changes.