What Is Individual Health Insurance?
Individual health insurance provides Americans with annual medical costs coverage. From checkups to acute emergency care, insurance prevents individuals from being hit with crippling healthcare fees in the event of injury or illness.
Before the introduction of the Affordable Care Act (Obamacare) in 2010, insurance providers could deny coverage due to medical status or charge exorbitant premium fees. But, now, affordable healthcare is available to all, no matter their health status.
However, the cost of that coverage is set to increase sharply in 2026 for many due to the scheduled expiration of the enhanced premium tax credits.
Individual health plans also offer ten essential benefits, including outpatient care, prescription drugs, prenatal and maternity care, hospitalization, mental health, and pediatric services.
Unless you have a qualifying life event, individual health insurance can only be purchased during the Open Enrollment Period (OEP). This period typically runs from November 1 to January 15 in most states, with final deadlines varying by state and coverage start date. 2026 Marketplace premiums (unsubsidized) are rising by an estimated 26% nationally, making it vital to shop carefully.
Maximum Out-of-Pocket (OOP) Limits are Higher
Even the costs you pay once enrolled are rising. For 2026, the federal maximum OOP limit for an individual is $10,600 (up from $9,200 in 2025). This is the most you’ll have to spend on deductibles, copays, and coinsurance before your health plan pays 100% of covered services for the rest of the year.
- Average Cost Increase: If the enhanced PTCs expire, individuals who currently receive subsidies are projected to see their average monthly premium payment more than double (a 114% average increase).
- The Subsidy Cliff Returns: The income cap for eligibility for any tax credit is set to revert to 400% of the Federal Poverty Level (FPL). For a single individual, 400% FPL is approximately $62,600 (based on 2025 FPL guidelines).
- High-Income Loss: Individuals with incomes above this limit (the “cliff”) will lose their entire subsidy and must pay the full, high unsubsidized premium, which could take up a large percentage of their income, especially for older enrollees.
- Lower-Income Increase: Even individuals with lower incomes who remain eligible will have to pay a higher percentage of their income toward their premium than they did in 2025.
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