Your health insurance is probably one of the most important decisions you make on a yearly basis. Unfortunately, it can also be the most confusing! So today, how do you find the best marketplace insurance plan on healthcare.gov? There are many factors to take into consideration when choosing a health insurance plan but basically it boils down to needs vs budget.
Understanding Your Budget
It’s actually much easier to understand our budget because it’s a hard number. There are a few costs you need to take into consideration:
- Monthly Premiums
- Cost Sharing Expenses (Copays & Coinsurance)
- Out of Pocket Maximums
Your monthly premium is the amount you pay out of pocket to keep your insurance active. On healthcare.gov, you may qualify for a tax credit. If so, this is where you will see those monthly savings. The are four “metal levels” of coverage:
Generally speaking, bronze will have those lowest monthly premiums and platinum will have the highest. If you qualify for a tax credit, it will be applied to your monthly premium regardless of which plan you choose.
Then there is the deductible. The deductible is the amount that you have to pay out of pocket before your insurance kicks in. So, for a service ordinarily covered by your insurance, you would be responsible for 100% of the cost before meeting your deductible. Generally speaking, Bronze plans will have the highest deductible and the deductibles will get lower as you move towards platinum.
The exception to the deductible are the essential benefits. Under the ACA, all marketplace insurance plans must cover services deemed essential benefits before you meet your deductible. So for these services, you have a copay or coinsurance as opposed to being responsible for the entirety of the cost even before your deductible is met. Some benefits are also covered at no cost.
Additionally, some plans have two separate deductibles to meet: one for health services, one for prescription drugs. If your plan has two separate deductibles, you’ll need to meet your prescription drug deductible by purchasing your medicine through your insurance before your insurance begins to cover a portion of the drug. This deductible would be entirely separate from your medical service deductible. If you are someone with a monthly prescription to fill, this may not be ideal.
Then there is the cost sharing aspect. Once you’ve met your deductible (or before if it is an “essential benefit”) you will pay for a portion of the cost and your insurance will pay for a portion. Even though there may be a pattern in the premiums and deductibles, the cost sharing is how the plans are delineated.
Bronze: Insurance will cover 60% and you are responsible for 40%
Silver: Insurance will cover 70% and you are responsible for 30%
Gold: Insurance will cover 80% and you are responsible for 20%
Platinum: Insurance will cover 90% and you are responsible for 10%
Finally, there are out of pocket maximums or limits. This is the max that you will pay out of pocket before your insurance covers 100% of the costs. Your insurance will keep track of the amount you pay out of pocket before your deductible is met as well as your copays or coinsurance. Once you hit the out of pocket limit, you won’t be responsible for the costs.
Your monthly premiums do not count towards the out of pocket limit. Also, your insurance will not count any bills for out of network services or benefits not covered by your plan. Additionally, you will still be responsible for these bills even after your limit has been met. In 2021, the max for an individual is $8,550 and for a family it’s $17,100. Your plan may offer lower limits and that will be indicated in the plan overview.
Identifying Your Needs
When perusing the plans on healthcare.gov, it’s easy to look at numbers on a page and gravitate towards what you perceive to be the least expensive option. BUT, insurance is really a little bit more personal than that. All plans will cover the “essential benefits” under the ACA.
You’ll need to identify your health needs:
- How often do you and your family visit the doctor?
- Other than the free services offered by healthcare.gov plans, how often do you make use of the other listed “essential benefits”?
- Do you have any conditions that require more frequent visits or in depth tests?
- Do you have any specialty medical needs that might require a plan with more elaborate benefits?
- Do you have any monthly prescriptions?
You’ll also need to understand the plan itself to determine which plans might best serve your needs:
- Do you need the flexibility of a PPO? Or can you work with an HMO or EPO?
- Do you have a network of doctors and hospitals you prefer? Do they accept your plan?
Picking an inexpensive plan may seem like a good idea, but if the doctors and benefits that you need to utilize are not covered by that plan, it won’t do you much good.
Additionally, picking a plan with a lower premium may seem budget friendly, but if you end up having to pay a larger deductible or larger copays for frequent visits, it may not actually be financially advantageous.
Additional Benefits on Healthcare.gov
This may seem like a lot to take into consideration, but it doesn’t even end there! If you need additional benefits such as dental or vision, you may want to check for a plan that offers those benefits. However, if you compare a healthcare.gov plan with dental to a plan without dental, it could be a significant difference. You may want to look into private insurance for those fringe benefits.
Then there are plans associated with HSAs. If you are looking to lower your income range or you’re interested in that triple tax benefit associated with HSAs, you may want a HDHP with the HSA option.
Finally, there are premium tax credits and your eligibility for those which can save you thousands per year.
If you’d like our assistance, you can reach us at iHealthBrokers at 888-918-0518. Our services are 100% FREE.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.