Shopping for the best health plan can be confusing, but luckily there are tips and tools available to you to make it easier! Let’s go over a few of them.
To start, when you’re shopping for coverage, it’s important to remember that you can only receive cost-saving subsidies by purchasing coverage through an Affordable Care Act (ACA) Marketplace. Subsides are provided to eligible individuals or families to help offset the cost of coverage including monthly premiums and/or cost-sharing such as your co-insurance or deductibles. Your state’s exchange can help you determine if you’re eligible. The good news is that thanks to the Inflated Reduction Act, expanded subsidies that were put in place during COVID-19 public health emergency have been extended and are available during the 2024 open enrollment period.
To get started you’ll need your employer and income information for every member of your household (for example, pay stubs, previous year tax filing, or W-2 forms) as well as your best estimate of what your tax household income will be for the year you are seeking coverage.
Before beginning to shop, make sure you’re familiar with some basic insurance terms and definitions. Understanding some of these more common terms can help you assess which plan may be best for your health and financial situation. It’s so important to remember that the lowest priced premium may not be the lowest overall cost plan once you factor in things like deductibles and copays.
When shopping for a plan you can easily view plan features side-by-side to compare costs and to see which plans have your favorite doctor and ongoing prescriptions in-network.
Know the Metal Levels
Metal levels refer to different tiers or categories of health insurance plans that are designed to help consumers compare and choose the level of coverage that best fits their needs. There are four main metal levels: Bronze, Silver, Gold, and Platinum, each of which has different cost-sharing and coverage characteristics. Here’s a brief overview of the differences between these metal levels:
- Lowest monthly premiums: Bronze plans typically have the lowest monthly premium payments among the metal levels.
- Highest cost-sharing: While the premiums are low, the out-of-pocket costs when you receive medical care (e.g., deductibles, copayments, and coinsurance) are higher compared to other metal levels.
- Suitable for: Individuals who are generally healthy and do not expect to use healthcare services frequently, but still want some financial protection in case of unexpected medical expenses.
- Moderate monthly premiums: Silver plans have moderate premium costs, falling between Bronze and Gold plans.
- Balanced cost-sharing: These plans offer a balance between premiums and out-of-pocket costs, making them a popular choice for individuals and families who anticipate moderate healthcare usage.
- Eligibility for Cost-Sharing Reductions (CSR): Silver plans are the only metal level that offers CSR subsidies, which can significantly reduce out-of-pocket costs for low-income individuals and families.
- Higher monthly premiums: Gold plans have higher monthly premiums compared to Bronze and Silver plans.
- Lower cost-sharing: Out-of-pocket costs are lower than with Bronze and Silver plans, making them a good choice for individuals who expect to use healthcare services more frequently or have ongoing medical needs.
- Suitable for: People who prioritize lower out-of-pocket expenses and can afford higher monthly premiums.
- Highest monthly premiums: Platinum plans come with the highest monthly premium payments.
- Lowest cost-sharing: These plans offer the most comprehensive coverage with the lowest out-of-pocket costs when you receive medical care.
- Suitable for: Individuals who want the highest level of coverage and are willing to pay higher monthly premiums to minimize their out-of-pocket expenses.
Brokers and Navigators Can Help
If you get stuck, have questions, or just don’t even know where to begin, health insurance brokers and navigators are available to help you at no cost. Plus, the premium prices they show you are the same that you would see on your own — there is no mark up for getting assistance.
You can find a list of licensed brokers on your state’s marketplace website or call the marketplace directly to find a broker near you.
Shopping for coverage can be daunting, but with a little help, you can ensure that you are picking the right coverage for you.