Individual and Family Plans are what most people use when they are not getting health insurance through an employer or a government program like Medicare or Medi-Cal. This section walks you through how these plans work in California, how Covered California fits in, and what to look for when choosing a plan for yourself or your family.
What Is an Individual & Family Plan?
An Individual & Family Plan (often called IFP) is health insurance you buy directly rather than through an employer. It can cover just you, you and your spouse, you and your children, or your entire household.
You can buy these plans:
- Through Covered California, the state’s health insurance marketplace
- Directly from a health insurance company (off-exchange)
Covered California is usually the best starting point because it is where most people qualify for financial help with their monthly premiums.
Who Typically Uses Individual & Family Plans?
You may need an Individual & Family Plan if:
- You are self-employed
- Your employer does not offer coverage
- You work part time and are not eligible for benefits
- You recently lost employer coverage
- You are between jobs
- You are not eligible for Medicare or Medi-Cal
These plans are designed to provide full medical coverage, not just emergency or limited benefits.
Where You Can Buy Coverage: Covered California vs Off-Exchange
You have two main paths:
Covered California
This is the state’s official marketplace. Through Covered California you can:
- Compare plans from multiple insurance companies
- See if you qualify for premium tax credits (financial help)
- See if you qualify for Enhanced Silver cost-sharing reductions
- Enroll online or with help from a licensed agent
If you want any kind of financial help, you must enroll through Covered California.
Off-Exchange (Direct with the Carrier)
You can also buy plans directly from insurance companies. These plans:
- Do not offer premium tax credits
- Can sometimes include slightly different networks or plan designs
- Are often used by people whose income is too high to qualify for subsidies
For most families, checking Covered California first is the smarter route.
Find plans and pricing in minutes
Compare options through the official Covered California marketplace. Prefer help? Call us and we’ll walk you through it.
You will be redirected to the official Covered California website to view plan options and complete enrollment.
Understanding Metal Tiers for Individuals & Families
Individual and Family Plans sold through Covered California follow a “metal tier” system. The metal level does not change the quality of care, but it does change how costs are split between you and the plan.
- Bronze
Lowest monthly premiums, highest out-of-pocket costs. Best for those who rarely use care and want protection mainly for larger emergencies. - Silver
Balanced premiums and out-of-pocket costs. Silver plans are the only ones that can be “Enhanced Silver” if you qualify based on income. - Gold
Higher premiums with low copays and no deductible for most services. Better for people who use care more often and want predictable costs. - Platinum
Highest premiums, lowest out-of-pocket costs. Best for people with frequent medical needs or ongoing conditions who want maximum protection.
There is also a Minimum Coverage or Catastrophic plan for certain people under 30 or those who qualify for a hardship exemption. These plans have very low premiums but very high deductibles and are mainly for worst-case scenarios.
Enhanced Silver Plans (Silver 73, 87, and 94)
One of the most important things to understand in the IFP world is the Enhanced Silver structure.
If your household income falls within certain limits, you may qualify for:
- Silver 73
- Silver 87
- Silver 94
These are upgraded Silver plans that:
- Keep your premium lower
- Reduce your deductible
- Reduce your copays and coinsurance
- Lower your out-of-pocket maximum
For many families who qualify, an Enhanced Silver plan is the best overall value because it combines financial help on the premium with better cost sharing when you use care.
How Costs Work for Individuals & Families
When you enroll in an Individual & Family Plan, you are balancing two main things:
- What you pay each month (premium)
- What you pay when you actually use care (deductible, copays, coinsurance, and out-of-pocket maximum)
If you:
- Rarely go to the doctor - A lower premium and higher deductible may make sense (Bronze or some Silver plans).
- Utilize medical services regularly or take ongoing prescriptions - You may be better off with a higher premium and lower out-of-pocket costs (Enhanced Silver, Gold, or Platinum).
A good way to think about it:
You are trading a higher or lower monthly payment for more or less risk later when you get care.
Networks and Plan Types for Individuals & Families
In California, Individual & Family Plans are usually offered as:
- HMO
- PPO
- EPO
HMO in the Individual Market
- You must select a primary care provider
- Referrals are usually needed for specialists
- No out-of-network coverage except emergencies
- Often the most affordable option
PPO in the Individual Market
- More freedom to see out-of-network doctors
- Usually higher premiums
- Out-of-network care has much higher costs
EPO in the Individual Market
- No primary care selection required in many cases
- No referrals for specialists
- No out-of-network coverage except emergencies
- Gives some flexibility while still keeping costs down
For most families, the key is making sure:
- Your primary care doctor is in-network
- Your child’s pediatrician is in-network
- Any important specialist is in-network
- Your preferred hospital is in-network
Checking networks before you enroll is extremely important.
Subsidies and Financial Help for Individuals & Families
Covered California uses your household size and estimated annual income to determine:
- Whether you qualify for a premium tax credit (monthly premium help)
- Whether you qualify for Enhanced Silver cost-sharing reductions
Important notes:
- You do not have to pay the tax credit back if your income ends up lower than estimated.
- You may owe some of it back if your income ends up significantly higher than what you reported.
- It is important to update your income during the year if your situation changes.
Most families are surprised at how much help they qualify for once they go through the income estimator.
Enrollment Timing for Individuals & Families
You cannot sign up for Individual & Family coverage at any time unless you have a qualifying reason.
Open Enrollment
Happens once a year and is the main time you can enroll or change plans. Dates are set each year by Covered California.
Special Enrollment Period
You may qualify outside of Open Enrollment if you:
- Lose employer coverage
- Move to California or to a different rating area in California
- Get married or enter a registered domestic partnership
- Have a baby or adopt a child
- Experience certain other qualifying life events
You usually have a limited window (often 60 days) to enroll after the event.
Enrollment Timing for Individuals & Families
You cannot sign up for Individual & Family coverage at any time unless you have a qualifying reason.
Open Enrollment
Happens once a year and is the main time you can enroll or change plans. Dates are set each year by Covered California.
Special Enrollment Period
You may qualify outside of Open Enrollment if you:
- Lose employer coverage
- Move to California or to a different rating area in California
- Get married or enter a registered domestic partnership
- Have a baby or adopt a child
- Experience certain other qualifying life events
You usually have a limited window (often 60 days) to enroll after the event.
Children’s Dental and Vision
For Individual & Family Plans through Covered California:
- Pediatric dental and vision are considered essential health benefits
- These are usually included as part of the medical plan or as a separate pediatric dental plan
- Adult dental and adult vision are separate and can be purchased as supplemental coverage
This is why you often see pediatric dental and vision mentioned even when the plan itself focuses on medical coverage.
Key Questions to Ask When Choosing an Individual & Family Plan
When you are comparing options, ask yourself:
- How often do I visit the doctor or need prescriptions?
- Do I want a lower premium with higher risk later, or a higher premium with more protection when I use care?
- Are my doctors and preferred hospitals in-network?
- Do I qualify for a subsidy or Enhanced Silver plan?
- Is anyone in the household expecting a major medical event, such as surgery or pregnancy, in the next year?
Answering these questions will help you narrow down the best options rather than guessing based on premium alone.
Find plans and pricing in minutes
Compare options through the official Covered California marketplace. Prefer help? Call us and we’ll walk you through it.
You will be redirected to the official Covered California website to view plan options and complete enrollment.