Individual & family
Coverage you buy for yourself, not through a job.
Four metal levels, one provider network, and the same deductible math on every plan. If you are shopping on the marketplace or straight from us, these are the plans you will see.
How the four tiers differ
Every Veranta individual plan covers the same set of services. What changes between tiers is the split: how much you pay every month, and how much you pay when you actually use the plan. A Bronze plan has the lowest premium and the highest deductible. A Platinum plan is the reverse. Silver sits in the middle and is the only tier where cost-sharing reductions apply if you qualify for them.
The provider network does not change with the tier. A doctor who is in network on Bronze is in network on Platinum.
| Essential Bronze 7500Choice PPO | Balance Silver 4500Choice PPO | Complete Gold 2000Choice PPO | Premier Platinum 1000Select HMO | |
|---|---|---|---|---|
| Monthly premium | $291 | $402 | $511 | $648 |
| Annual deductible | $7,500 | $4,500 | $2,000 | $1,000 |
| Family deductible | $15,000 | $9,000 | $4,000 | $2,000 |
| Out-of-pocket maximum | $9,450 | $8,200 | $6,500 | $4,000 |
| Primary care visit | $45 before deductible | $30 before deductible | $20 before deductible | $10 before deductible |
| Specialist visit | After deductible | $65 | $45 | $25 |
| Urgent care | $85 | $60 | $45 | $25 |
| Emergency room | After deductible | $500 then 20% | $350 then 20% | $250 |
| Generic drugs (Tier 1) | $25 | $15 | $10 | $5 |
| Preventive care | $0 | $0 | $0 | $0 |
| Virtual visits | $0 | $0 | $0 | $0 |
| Referral needed? | No | No | No | Yes, from your PCP |
Platinum is not sold everywhere. In 2026 the Premier Platinum tier is available in six of our fourteen states. The plan finder will only show it if it is offered where you live.
What every individual plan includes
- Preventive visits, screenings, and immunizations at no cost
- Primary and specialty care
- Hospital and inpatient care
- Emergency services, in or out of network
- Prescription drugs on the 2026 formulary
- Mental health and substance use treatment
- Maternity and newborn care
- Laboratory and imaging
- Rehabilitation and habilitation services
- Pediatric dental and vision to age 19
- Virtual urgent care, 24 hours a day
- A 24-hour nurse line
- Adult dental, unless you add it
- Adult vision hardware, unless you add it
How to enroll
-
Check that your doctors are in network
Do this first. Changing plans later because a doctor is out of network is the single most common reason members call us in February.
-
Look up your prescriptions
The 2026 drug list shows the tier each drug falls into and whether it needs prior authorization.
-
Estimate your total cost, not your premium
Premium plus expected out-of-pocket. If you see a specialist monthly, the cheapest premium is rarely the cheapest year.
-
Enroll and pay the first premium
Coverage does not start until the first payment clears, even if the application is accepted. Enroll by December 15 for a January 1 start date.
Dates that matter
| Date | What happens |
|---|---|
| Nov 1, 2025 | Open enrollment begins for the 2026 plan year. |
| Dec 15, 2025 | Last day to enroll for coverage starting January 1. |
| Jan 1, 2026 | 2026 coverage begins for anyone enrolled by December 15. |
| Jan 15, 2026 | Open enrollment closes. After this, you need a qualifying life event. |
| Feb 1, 2026 | Coverage begins for anyone who enrolled between December 16 and January 15. |
| Any time | A qualifying life event opens a 60-day special enrollment period. |
Qualifying life events include losing other coverage, moving to a new coverage area, marriage or divorce, having or adopting a child, and a change in income that affects subsidy eligibility.
Questions we get asked
Will I qualify for a subsidy?
That depends on your household income and size, and it is decided by the marketplace rather than by us. Roughly four out of five people who buy their own coverage qualify for something. Subsidies only apply to marketplace plans, so if you buy directly from Veranta you pay the full premium.
What is the difference between buying on the marketplace and buying from you directly?
The plans are the same. The difference is that only marketplace plans can carry a subsidy, and only Silver marketplace plans can carry cost-sharing reductions. If you know you do not qualify for either, buying directly is simpler and the price is identical.
Can I keep my doctor?
If they are in the Veranta Choice PPO or Veranta Select HMO network for 2026, yes. Networks are set each plan year, so a doctor who was in network in 2025 is not automatically in network in 2026. Check before you enroll.
What happens if I miss open enrollment?
You cannot buy an individual plan until the next open enrollment unless you have a qualifying life event. Medicaid and CHIP have no enrollment window, so if your income has changed it is worth checking those first.
Does the deductible reset if I switch tiers mid-year?
Yes. A tier change is a new plan, and a new plan means a new deductible and a new out-of-pocket maximum. Anything you paid toward the old plan's deductible does not carry across.
Is my whole family on one deductible?
There are two: an individual deductible and a family deductible. Any one person's costs stop counting against the individual deductible once they hit it, and the family deductible is met by the household's combined spending. Whichever is met first applies.
Premiums shown are illustrative examples for a 40-year-old non-smoker in Hartford County, Connecticut, for the 2026 plan year, before any advance premium tax credit. Your rate depends on your age, location, tobacco use, and the number of people on the plan. Benefit amounts are summaries. The plan documents govern in every case.
Veranta Health is a fictional organization. Nothing on this page is a real insurance product or an offer of coverage.
Not sure which tier fits?
Member Services can walk through the math with you before you enroll, and there is no charge for the call. Monday through Friday, 8am–8pm ET.