"Your Personal Insurance Broker"

Gerczak Insurance Agency, Inc. | 901 A Regester Parkway Richmond VA 23226 US | +1.8774372925

Individual health

To the Marketplace... Or Not?  The answer is... well, it depends. 


During an Enrollment Period

If you do not have coverage through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source and are within an Enrollment Period, you are eligible to enroll or change health insurance plans within the Marketplace.  The Marketplace is the State's price comparison website, also known as "the exchange", for subsidized health insurance plans offered by private insurance companies.  One can enroll into or change plans through the Marketplace during the Open Enrollment Period, or if you qualify for a Special Enrollment Period such as, but not limited to:

  • marriage or divorce
  • having a baby or adopting a child
  • losing other health coverage
  • permanently moving outside your plan’s coverage area
  • gaining citizenship or lawful presence in the U.S.
  • a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions if already enrolled in a Marketplace plan


Outside of an Enrollment Period

If you do not have coverage through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source and are outside of an Enrollment Period, you are not eligible to enroll or change health insurance plans within the Marketplace. You would then have the option to select an "off-exchange" plan which are also offered by private insurance companies, but have one significant difference:  "off-exchange" plans have neither subsidized premiums nor other cost-sharing reductions.  There are other short-term health insurance options as well, but not all short-term plans meet the "minimum essential coverage" requirement set forth in the Affordable Care Act (ACA).


Not having health insurance that meets the requirement of "minimum essential coverage" one would be assessed a penalty equal to the higher of either:

  • 2% of your yearly household income, or
  • $325 per person for the year ($162.50 per child under 18) with a maximum penalty per family of $975.