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Health Under 65

Health coverage for you and your family

Individual and family health plans, ACA Marketplace plans and short-term options for people under 65. Start with three questions, or call or text Manuel.

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Three questions

How can we help you?

Step 1: which coverage do you need?

Nothing here signs you up for anything. You choose what happens next.

Health

Your options, and what to check before you pick

Individual and family plans are health insurance you buy for yourself or your family, rather than through an employer.

ACA Marketplace plans are sold through the Health Insurance Marketplace. They must cover pre-existing conditions, and depending on your income you may qualify for savings.

Short-term and limited-benefit plans can help fill a gap. They generally don’t have to follow federal Marketplace rules, so read what they cover and what they leave out.

Start with your doctors. A plan only works well for you if the people you already see are in its network.

Then your prescriptions. Two plans with the same premium can cost very different amounts once your medications are counted.

Then the costs after care: what you pay before the plan starts paying, and the most you could pay in a year.

HealthCare.gov Open Enrollment for 2027 coverage runs November 1 to January 15. Outside that window, you usually need a qualifying life event, like losing other coverage or moving, to enroll in a Marketplace plan.

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Costs

What you pay, and when, across a plan year

What you pay, and when, across a plan year An axis of annual covered spending crossed by two markers. Before the deductible is met you pay every covered bill at the negotiated rate and the plan pays for preventive care at no cost to you. Between the deductible and the out-of-pocket maximum you pay a copay or coinsurance share on each bill and the plan pays the rest. Once the out-of-pocket maximum is met the plan pays 100 percent of covered care through year end and you pay nothing more for in-network care. The premium runs underneath all three stages: it is due every month whether or not you use care, and none of it counts toward either marker. The premium tax credit lowers the premium only. Cost-sharing reductions move both markers and apply to Silver plans only. What you pay, and when, across a plan year Structure: HealthCare.gov (CMS). Not to scale: every plan sets its own amounts. Annual covered spending Deductible met Out-of-pocket maximum met Cost-sharing reductions move both markers left · Silver plans only Before the deductible Between the markers After the maximum You pay Every covered bill, at the negotiated rate Your coinsurance or copay on each bill Nothing more this plan year, in network Plan pays Preventive care at no cost to you The rest of each bill, after your share 100% of covered care, through year end Premium Due every month, used or not, and none of it counts toward either marker. The premium tax credit lowers this line, and only this line. Both markers reset at the start of each plan year. Out-of-network care may not count toward either. Some plans charge a set copay for certain visits or drugs before the deductible. Check the plan summary. What you pay, and when, across a plan year An axis of annual covered spending crossed by two markers. Before the deductible is met you pay every covered bill at the negotiated rate and the plan pays for preventive care at no cost to you. Between the deductible and the out-of-pocket maximum you pay a copay or coinsurance share on each bill and the plan pays the rest. Once the out-of-pocket maximum is met the plan pays 100 percent of covered care through year end and you pay nothing more for in-network care. The premium runs underneath all three stages: it is due every month whether or not you use care, and none of it counts toward either marker. The premium tax credit lowers the premium only. Cost-sharing reductions move both markers and apply to Silver plans only. What you pay, and when, across a plan year Structure: HealthCare.gov (CMS). Not to scale: every plan sets its own amounts. Annual covered spending Before the deductible You pay Every covered bill, at the negotiated rate Plan pays Preventive care at no cost to you Between the markers You pay Your coinsurance or copay on each bill Plan pays The rest of each bill, after your share After the maximum You pay Nothing more this plan year, in network Plan pays 100% of covered care, through year end Cost-sharing reductions move both markers up the axis · Silver plans only Deductible met Out-of-pocket maximum met Premium Due every month, used or not, and none of it counts toward either marker. The premium tax credit lowers this line, and only this line. Both markers reset at the start of each plan year. Out-of-network care may not count toward either. Some plans charge a set copay for certain visits or drugs before the deductible. Check the plan summary.
Structure: HealthCare.gov (CMS). Not to scale; every plan sets its own amounts.

Coverage Manuel can help with

Health under 65MedicareTurning 65Medicare AdvantageMedicare SupplementDental & VisionLife insuranceFinal expenseHospital indemnityMedicare guides

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Questions

Questions people ask

HealthCare.gov Open Enrollment for 2027 coverage runs November 1 to January 15. If you enroll by December 15 and pay your first premium, coverage can start January 1.

A qualifying life event, like losing other health coverage or moving, can open a Special Enrollment Period. You usually have 60 days from the event to enroll.

No. Short-term plans generally don’t have to follow federal Marketplace rules, including the rules about pre-existing conditions.

Next step

Ready when you are

Answer three quick questions, or call or text Manuel about health coverage for your family.

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