Individual & Family Health Insurance Plans
We get it. There are a lot of plans out there!
You’re not alone. Let us help you navigate your options.
Shopping the Federal Marketplace for Individual and Family Plans: When you shop for health insurance on the Federal Marketplace (often referred to as the “Exchange”), you’re exploring plans that are approved and regulated by the federal government. One of the main advantages of using the Marketplace is the possibility of receiving subsidies to pay for a portion of your monthly premiums. The subsides are based on household size and income, but most people are eligible for them. Click the Get a Quote button to learn more.
Shopping Direct with GHC-SCW for Individual and Family Plans: Choosing to shop directly with GHC-SCW means you’re purchasing a plan directly from us without going through the Federal Marketplace. Shopping outside the Marketplace, you won’t be eligible to receive the federal tax credits or subsidies, even if you would otherwise qualify based on your income. Get a direct quote from GHC-SCW here.
Individual and Family Plan Renewals
Looking to renew your GHC-SCW Individual and Family Plan policy? You came to the right place.
New For 2024 Plans
- Primary Care Preferred Plans will include routine eye exams with no copay!
- Dane County Individual and Family plan members will need to select a primary care provider in the GHC-SCW Select Network.
Top 5 Reasons to Choose GHC-SCW for Individual Coverage
- Best-in-class primary care + specialty care partners. As a GHC-SCW member-owner, you have access to world-class primary care and an elite network of specialty and hospital care.
- Be part of something bigger. Join our non-profit health care Cooperative and as a member-owner, participate in the direction of the organization. Use your voice and your vote to make your health plan work for you. Learn what it means to be part of a Cooperative.
- Pay for high quality service, nothing less. With the GHC Experience GuaranteeSM, we give you the power to decide if your experience was worth what you paid or ask for a refund. We think that’s just the right thing to do.
- Experience full, patient-centered care. Your care team is designed around you and your needs. As your health evolves, we’ll expand your health care team to meet your needs. Think behavioral health providers and physical therapists who work alongside your primary care provider to improve your health.
- Maximize your well-being. Our unique Member-Owner Rewards can help you customize your path to health and well-being. Discover the advantages of our member-exclusive rewards program.
Learn More About GHC-SCW Benefits
Members pay $0 for most GHC-SCW preventive care services. This includes primary care office visits, urgent care visits, chiropractic office visits, preventive benefits, mental health outpatient services and more. Get your employees on the road to better health with our innovative health plan.
New for 2024: primary care preferred plans will include vision coverage!
You have questions; we have answers.
We’ll help you make a good decision about your family’s health coverage. Call or email anytime!
Pam Hying
Individual and Medicare Sales Executive
Understanding Health Insurance
Premium
Your premium is what you will pay each month to have health insurance.
It’s like your monthly fee for your favorite TV streaming service. Even if you only watch one or two shows a month, you still pay the same monthly fee for access. If you buy through our Marketplace or HealthCare.gov, you may be able to lower your costs with a tax credit that goes toward your monthly premium.
Deductible
Your deductible is what you pay every year for health care before your insurance company starts paying. Usually, high deductible plans have lower monthly premiums.
For example: If you have a $2,000 deductible, your insurance company might not pay until you’ve paid $2,000 in health care costs.
Some plans may cover costs for things like an annual check-up before you’ve paid your full deductible. When you’re shopping for plans, look at what counts toward the deductible.
Coinsurance
After you have paid your deductible for the year, you still might have to pay a part of your medical expenses. This is called coinsurance.
For example: Say your plan has a 20% coinsurance and $2,000 deductible. If you reach your deductible halfway through the year, you’ll pay $20 of a future $100 bill. Then your insurance company would pay the other $80.
Not all plans have coinsurance, so make sure to see if the plan you’re looking at does.
Out-of-Pocket Maximum
This is the total you’ll pay each year toward your medical costs. It combines your deductible costs, copay and coinsurance.
Once you reach your out-of-pocket maximum, your insurance company will pay for the rest of your approved health care.
Premiums don’t count toward your out-of-pocket maximum. Also, out-of-network provider bills may not count.
- Catastrophic
- Bronze
- Silver
- Gold
- Platinum
The most important things you need to think about are:
- Monthly cost: how much can you afford to pay each month in your premium
- How often you see your provider: if you routinely need care, you might want to pick a plan that has lower costs for care
Open Enrollment is the time of year when you can pick a health insurance plan.
If you’re shopping for individual coverage and don’t qualify for a plan through your employer, open enrollment is November 1 through January 15 on the marketplace.
You’ll only be able to change your health insurance outside of open enrollment if you qualify for a Special Enrollment Period.
Yes, if you shop for GHC-SCW plans through this link, you can still qualify for government tax credits toward your monthly premiums. It will take into account your age, how many people are in your household and your total income to determine if you qualify.
Catastrophic
(Only for people under 30 or who have an exemption)
- Very lowest monthly premium
- Very high costs when you need care
- Covers: essential health benefits, some preventive services and a few primary care visits a year
- Choose this if: You’re looking for lower monthly costs, don’t need a lot of medical care and have money saved in case of a serious medical issue. You’ll have to pay out-of-pocket for any high costs until you meet your deductible. You also don’t qualify for Medicaid or for help paying for your health plan through subsidies.
Bronze
- Low monthly premium
- High costs when you need care
- Deductibles: you may pay thousands a year in medical costs before your health plan starts to pay
- Choose if: You want to keep your monthly costs low while also protecting yourself from high-cost emergency medical issues. You’ll have to pay more when you need to see your provider for routine care.
Silver
- Medium monthly premium
- Medium costs when you need care
- Choose if: you qualify for cost-sharing reductions or if you want more of your routine care to be covered by your health insurance plan in exchange for a slightly higher monthly premium.
Gold
- High monthly premium
- Low costs when you need care
- Choose if: You think you’ll need to see your provider often because of routine care or illness. You’re going to pay more each month, but your out-of-pocket costs will be lower.
Platinum
- Highest monthly premium
- Lowest costs when you get care
- Choose if: You want nearly all of your care costs to be covered in exchange for paying more each month for your premium.