Consumer Guide to Health Care - Buying Health Insurance as an Individual

Look for other access to insurance

If you do not have access to any employer-based insurance, do you belong to or could you join any group or association that might offer you a discount on health insurance? Keep in mind that some of these plans may have limited coverage, so make sure you know exactly what you are getting.

Affordable Care Act

Information for Wisconsin about the Health Insurance Marketplace under the Affordable Care Act is available from HealthCare.gov. The Health Insurance Marketplace is a new way to get coverage that meets your needs.  More information from HealthCare.gov.

Enrollment Wisconsin (EnrollWI.org) Wisconsin: Provides resources for consumers (people needing to apply for health insurance using the federal Marketplace) as well as for organizations helping people to apply. An online Enrollment Directory is available on the site. It lists Wisconsin organizations that provide health insurance enrollment services, including organizations that are Certified Application Counselor Organizations - those who can assist with enrollment in the federal Marketplace.

Health savings accounts

There are several types of health spending accounts on the market today. Health Savings Accounts (HSAs) are one type of health spending account. Information on HSAs is available.

Your rights and obligations

Finding insurance as an individual means special concerns, including generally higher costs and less complete coverage. In addition, your health can affect the type of coverage you can get.  Before you can buy an individual policy you must give the insurance company information about your health. This process is called medical underwriting.

Some things to look out for

As the cost of health care rises, health insurance scams are becoming more common.  Watch out for unlicensed insurers that offer cheap coverage but then refuse to pay claims.  Also be wary of so-called "discount health plans" that are not really insurance at all, but advertise in ways that make it sound as if they are.  When in doubt, contact Wisconsin's Office of the Commissioner of Insurance at (608) 266-3585 (from Madison) or (800) 236-8517 to confirm that you are working with a licensed insurer.  Remember, if it sounds too good to be true, it probably is.

  • Don't Be a Victim of Unlicensed Insurers:  This information from the Wisconsin Office of the Commissioner of Insurance (OCI) can help you avoid the pitfall of purchasing a plan that is not licensed in the state of Wisconsin.  OCI also offers a searchable directory of  insurers licensed in the state of Wisconsin.
  • OCI warns about a rise in fake insurance policies and what you can do to protect yourself. The OCI urges consumers to STOP before signing anything or writing a check, CALL the OCI at 1-800-236-8517, and CONFIRM that the company is licensed to do business in Wisconsin.
  • The National Association of Insurance Commissioners offers more tips to protect yourself against illegal health plans (PDF, 27 KB). NAIC also offers Insure U, a good place to learn about health insurance options in a variety of life situations and how to shop for insurance safely.
  • The FBI offers ways to protect yourself against fraud, including health care fraud: Common Fraud Schemes. Scroll down to find tips for avoiding fraud in health care and health insurance.
  • Fighting Health Care Fraud Toolbox from AHIP, the national trade association representing the health insurance industry, lists some ways consumers can protect themselves and their loved ones from health care fraud.
  • Tips on buying individual health coverage are provided by Insure.com.

Working with an agent

If you are trying to decide whether to work with an insurance agent or to contact the insurance companies directly, keep in mind that some insurance companies only work through agents/brokers while some agents only offer insurance for one or two insurance companies. If you decide to work with one or more agents, check the OCI website to be sure their licenses are currently active.

Buying insurance on the Internet

There are several commercial tools such as Insure.com, eHealthinsurance.com, and healthcareshopper.com available on the Internet that provide instant insurance quotes. Before you use this approach, consider the precautions (PDF, 27 KB) suggested by the National Association of Insurance Commissioners.

Last Revised: July 20, 2015