Health Insurance Basics

Three basic questions about individual health insurance

1. What is individual health insurance vs. group insurance?

Individual health insurance — coverage you buy on your own from an insurance company. 
Group health insurance — coverage you obtain through your employer.

You buy individual health insurance because you may be: 

  • Unemployed
  • Self-employed
  • ​Early retired

You pay the entire premium each month. 

You can buy it by:

  • Working directly with an insurance company
  • Working with an insurance agent in your town
  • ​Going on the internet 

You can also buy this coverage through your state exchange or federal marketplace.  

If you enroll through Healthcare.gov, you may be eligible for subsidies based on your expected income level: 

  • Advance Premium Tax Credits: Lower monthly premium payments.
  • Cost Share Reduction plans: Lower the amount you have to pay for deductibles, copayments and coinsurance.

To see if you quality, visit Healthcare.gov.

2. What doctors can I see?

Your individual plan will have a network of doctors and other providers you can choose from. With some plans, you can use a doctor who is not in the network but you’ll end up paying more — sometimes much more.

In some plans, you’ll pay a deductible — the amount you pay before your plans starts to pay for covered services.

Find out more and see if your doctor is in the Innovation Health plan network.

More to remember:

  • Doctors and other providers are independent contractors.
  • They don’t work for Innovation Health or Aetna.
  • Neither Innovation Health nor Aetna provides care or guarantees access to health services.

3. Are my prescriptions covered?

Many individual health plans cover your prescriptions. A  deductible — the amount you pay before your insurance begins paying benefits — is often required before the plan pays. 

Plan details differ.  So be sure to check how a plan covers:

  • Preferred drugs — These are brand-name drugs in the plan’s formulary or list of approved drugs.
  • Nonpreferred — These are brand-name drugs not in the plan’s formulary. You usually pay more for these drugs.
  • Generic drugs — These have the same active ingredients as brand-name drugs but usually cost the least. 

Health Plans for Individuals, Families and the Self-Employed are underwritten by Innovation Health Plan, Inc. or Innovation Health Insurance Company (Innovation Health). Innovation Health Insurance Company and Innovation Health Plan, Inc. are affiliates of Inova and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Innovation Health.

This material is for information only. Health insurance plans contain exclusions and limitations. Not all services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Investment services are independently offered by the HSA Administrator. Information is believed to be accurate as of the staging date; however, it is subject to change. 

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