How to Buy Health Insurance in 6 Steps: A Guide for the Self-Employed

There are three ways to buy health insurance: through an employer, through the marketplace, or through a broker. If you’re self-employed, you’ll need to use the marketplace to choose from various health insurance options. If you prefer not to navigate the process yourself, a broker can help guide you and provide personalized advice based on your specific health needs and budget.



Here are the steps for self-employed individuals to buy health insurance:

1. Understand the Enrollment Periods

If purchasing health insurance outside of an employer plan, be aware of the enrollment periods. You are typically only eligible to enroll in a health insurance plan during the open enrollment period, usually once a year and starting on or around November 1. 

However, exceptions known as qualifying life events may qualify you for a special enrollment period. If you experience a major life event, such as getting married, having a child, losing other health coverage, or moving to a new residence, you may be eligible for a special enrollment period. Ensure you’re in one of these enrollment periods before proceeding.

2. Set Up an Account in the Marketplace or Seek a Broker's Assistance

If you decide to use the marketplace, setting up an account is the next step in purchasing health insurance. This generally requires providing basic information, including your name, address, and income level. This process will also determine your eligibility for different insurance plans.

If you decide to find a health insurance broker, you will need to go through a similar process of providing information so the broker can identify your options.

3. Determine Eligibility for Premium Tax Credits (Optional)

Depending on your income level, you may qualify for premium tax credits that can significantly reduce your monthly health insurance costs. The government provides these tax credits to help low- and middle-income individuals and families afford health insurance. The amount of credit you’re eligible for is based on a sliding scale, with higher credits for those earning less. 

When you apply for coverage in the marketplace, the application will automatically calculate your potential tax credit based on your estimated income for the upcoming year. If you qualify, you can apply these credits to the monthly premiums of your chosen insurance plan.

4. Explore and Compare Plan Options

Once you’re set up on the marketplace and have determined your credit eligibility, you can explore health insurance plan options. If you’re using the marketplace directly, the system provides a range of plans categorized into tiers. These tiers do not signify the quality or amount of care the plans offer but represent how you and your plan share costs.

For example, Bronze plans generally have lower monthly premiums but higher costs when you get care. Platinum plans usually have the highest premiums but the lowest out-of-pocket costs when you receive care. Each tier provides plan options with varying networks, pharmaceutical coverages, and co-pays. Review each plan carefully, considering the cost, benefits, coverage, out-of-pocket maximums, and which providers are in-network.

If you are working with a broker, they will provide you with a curated list of options tailored to your needs and financial situation. Brokers can break down the complexities of each plan, helping you understand the pros and cons of each.

5. Select Your Plan and Formalize Enrollment

Once you have selected a plan that fits your needs, it’s time to formalize your enrollment. If you’re using the marketplace, you can do this directly on the website. You will be guided through the application process, which usually involves reviewing your selected plan, completing a final eligibility check, and setting up your premium payments.

When purchasing through a broker, they’ll guide you through a similar process. Typically, this will involve completing and signing an application form in hardcopy or online. The broker will then submit this application to the insurance provider on your behalf.

Regardless of which route you take, be sure to thoroughly review all information before finalizing your application. Confirm the details of your plan, including the premium, coverage, out-of-pocket maximums, and network of providers. 

After submitting your application, you should receive enrollment confirmation from the insurance provider through mail or email. The confirmation will include important details about your coverage start date and payment information. Keep a record of this information for your reference.

Remember, purchasing health insurance is a significant decision, and it’s essential to take the time to make an informed choice. Don’t hesitate to seek help if you need it, whether from a marketplace representative, a broker, or a knowledgeable person in your life.

6. Pay Your Premium and Pick a Healthcare Provider

After finalizing your health insurance enrollment, the final step is to schedule your premium payments. Paying your premium is critical as it keeps your policy active and lets you use your coverage. Your premium is typically billed monthly by automated checking account payments, credit card, check, or other online payments. 

Once you’ve arranged for your premium payments, it’s time to choose a Primary Care Provider (PCP). A PCP is your main healthcare provider in non-emergency situations. Your PCP’s role is to:

• Provide preventive care 
• Identify and treat common medical conditions
• Assess the urgency of your ongoing medical problems 
• Make referrals to specialists when necessary

The choice of PCP often depends on your specific health needs and preferences. This could be a doctor, a nurse practitioner, or a physician assistant. Ensure your chosen PCP is in-network for your insurance plan to get the best financial terms. If you have an existing doctor you prefer, check whether they accept your insurance. If you don’t have a preferred doctor, search your insurer’s network to find a provider near you.

How to Buy Health Insurance FAQs

When is open enrollment for health insurance in 2023?

Open enrollment for health insurance typically falls in the last quarter of the year. In 2023, the open enrollment period in most states runs from November 1, 2023, to January 15, 2024. During this time, qualifying individuals can choose, switch, or renew their health insurance plans for the upcoming year. 

Note that these dates are subject to change, so check Healthcare.gov or other state exchange websites or consult with an insurance broker as open enrollment draws near.

How can I get health insurance after open enrollment?

If you miss an open enrollment period, you still have two main options to obtain health insurance. The first is to see if you qualify for a special enrollment period. You may qualify for special enrollment if you’ve married, had a child, or lost health insurance through a provider. If you qualify for a special enrollment period, you typically have up to 60 days following the event to enroll in a plan.

The second option for securing coverage outside of open enrollment is applying for Medicaid or the Children’s Health Insurance Program (CHIP). You can apply to these programs at any time during the year. Eligibility is determined by income and family size. If you’re eligible, your coverage can start immediately, any time of year.

What documents do you need to apply for health insurance?

The documents you need to apply for health insurance can vary depending on your situation and how you’re planning to get coverage. In general, you’ll need the following documents to apply for health insurance:

• Proof of identity: This could be a driver’s license, passport, or other government-issued identification.
• Proof of citizenship or immigration status: U.S. citizens can provide a U.S. passport, a birth certificate, or a Certificate of Naturalization. Non-citizens may need to provide a Green Card, an Employment Authorization Document, or an I-94 form.
• Proof of income: This might include recent pay stubs, W-2 forms, or a tax return from the previous year. You may need to provide a profit and loss statement if you're self-employed.
• Current health insurance policy number: If you’re enrolling because you lost coverage provided through an employer, you may need to give details about your previous plan.