How to Choose the Right ACA Health Insurance Plan

Jenifer Dorsey
2018-10-08 November 21st, 2017 |
Read time: 2 minutes

Choosing health insurance coverage for you and your family is no small decision. Even though the Affordable Care Act requires that all qualified major medical insurance plans cover certain preventive services and include essential health benefits at no additional cost, there are nuances.

How to select health insurance coverage

1. Consider your healthcare needs and budget

Consider your annual budget for monthly premium and out-of-pocket medical expenses. Ask yourself how often you anticipate using your health insurance in the upcoming year and for what.

If you have a pre-existing health condition and/or expect to use your health plan for more than preventive care, you may want to consider what is most cost-effective in your situation. The plan with the lowest monthly premium may not be the best deal.

The four coverage metal levels help make cost-sharing expectations obvious—after deductible and premium:

  • Bronze plan – 60%of covered medical expenses paid by the plan; 40% by the consumer
  • Silver plan – 70% of covered medical expenses paid by the plan; 30% by the consumer
  • Gold plan – 80% of covered medical expenses paid by the plan; 20% by the consumer
  • Platinum plan – 90% of covered medical expenses paid by the plan; 10% by the consumer

Bronze plans may have the lowest monthly premiums and highest cost-sharing. Platinum plans will likely have the highest monthly premiums and lowest cost-sharing.

2. Consider the health plan benefits

While all health plans are required to have the same minimum coverage for the 10 essential health benefits and preventive care, plans will differ beyond that as far as what treatments, services, prescription drugs, specialists, and other medical expenses are covered and at what rate.

As you compare plans, consider how each covers care and services such as the following:

  • Urgent care visits
  • Emergency room care
  • In-patient hospital care
  • Surgical care
  • Mental health services
  • Out-of-network care

Ask yourself these questions:

  • What is the copay for doctor office visits?
  • How much is coinsurance?
  • Are the brands of prescription drugs you take covered?

3. Consider the provider networks

If you have a preferred doctor or hospital, you want to be certain they are covered by the plan you are considering.

Your state-based or federally facilitated health insurance exchange may provide this information when you look at plan information. If it does not, you may visit the carrier’s website and search its provider directory. However, it is important to note that not all directories are up to date, and you may want to call the carrier to verify.

4. Consider the health insurance carrier (aka insurance company)

You want to know you can trust the insurance company providing your health plan. Using rating websites such as A.M. Best rating can help you determine a health insurance company’s consumer satisfaction and financial strength.

Read our article on finding a reliable carrier for more tips.

5. Consider your premium tax credit eligibility

Estimate your subsidy using the Health Care Reform Calculator. This may help you determine whether or not you wish to buy from an exchange.

Tax credits are only available to those who buy exchange-based coverage; however, those whose household income is too high and disqualifies them from receiving Obamacare subsidies may find lower rates away from the exchange. Shop around on and off the exchange to determine what is best for you.

With the money you save on monthly premium, you may want to invest in additional coverage such as dental, hospital, supplemental, or telemedicine plans.

For help selecting a plan and additional health benefits to help lower your out-of-pocket healthcare expenses, contact a health insurance producer. Use Agent Finder to search for local assistance.


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Originally Published On October 31st, 2016