How to Choose a Health Insurance Plan
Selecting a health insurance plan that is right for you and your family is a big decision. That is why we have made it easy to help you compare plans by focusing on three essential areas:
- Plan options under the Affordable Care Act
- Cost of each plan
- Network of doctors and hospitals
With these guidelines, you can select a health insurance plan that fits your needs.
Understand Affordable Care Act health insurance plans
The Affordable Care Act (ACA) health insurance plans are organized into four categories: Bronze, Silver, Gold and Platinum. The plans differ only in how you and your insurance provider share the overall cost. If eligible, you may also receive an Advanced Premium Tax Credit from any of the four plans, which helps you save.
| Plan | Bronze | Silver | Gold | Platinum |
|---|---|---|---|---|
| What your plan pays | 60% | 70% | 80% | 90% |
| Your cost | 40% | 30% | 20% | 10% |
| Plan | Bonze |
|---|---|
| What your plan pays | 60% |
| Your cost | 40% |
| Plan | Silver |
| What your plan pays | 70% |
| Your cost | 30% |
| Plan | Gold |
| What your plan pays | 80% |
| Your cost | 20% |
| Plan | Platinum |
| What your plan pays | 90% |
| Your cost | 10% |
With a Bronze plan, you receive the lowest monthly premium, but with a high deductible. A Bronze plan is your best choice when you do not visit your doctor much but want peace-of-mind protection for medical emergencies.
Silver planSilver plans offer an average monthly premium, but a lower deductible than a Bronze plan. If you qualify, you can save even more with the Silver plan, including an Advanced Premium Tax Credit and Cost-Sharing Reductions.
Gold planSelecting a Gold plan means the monthly premium is higher, and the deductible is low. Gold is the preferred plan if you require a lot of health care. Almost all of your routine medical care costs are covered.
Platinum planWhen you choose a Platinum plan, you receive the highest monthly premium and the lowest deductible. Platinum is the preferred plan when you rely on routine medical care regularly and want the most coverage.
Learn more about ACA open enrollment for health insurance for individuals and families so you know when to apply.
Compare health insurance costs
Now that you have an idea of which ACA plan may fit your needs, you can more closely compare costs.
Because health insurance costs are more than just the monthly premiums, you will want to be sure to include the deductible in your final cost. This will give you a more accurate estimate of the copays and coinsurance you might pay throughout the year.
Tip: If you are having trouble fitting health insurance into your budget, you can check if you are eligible for a health insurance subsidy, which is financial help from the government to pay for your health care coverage. If you qualify, you may be able to lower or completely eliminate your premium.
Know more about plan networks
The type of plan network you choose defines your options for doctors, hospitals and clinics. Be sure to double check that your plan network includes your preferred health care providers.
Limited networks may cost less if you do not mind using network-only providers, but make sure your in-network providers are also conveniently located.
Preferred Provider Organization (PPO)
PPO networks offer reduced costs if you use network health care providers.
Exclusive Provider Organization (EPO)
An EPO typically offers a local network of doctors and hospitals to choose from. However, if you receive care outside of the network, it will not be covered, except in the event of an emergency.
Health Maintenance Organization (HMO)
An HMO limits coverage to health providers who are under contract with the HMO company. HMO networks may be smaller. Most HMOs require you to select a primary care provider to be your primary point of contact for your medical care, including receiving a referral if you need to see a specialist.
Do not forget dental and vision insurance
While calculating all your health insurance options, you may want to include dental and vision coverage. All ACA plans include dental and vision for children and some plans may provide coverage for adults. If the medical plan you select does not include dental and vision coverage, Empire offers stand-alone dental and vision plans to complete your overall health protection.
Receive 1-on-1 guidance selecting a health insurance plan
Empire is here to help you choose the right plan. Compare ACA plans, costs and network types quickly and easily, plus tailor your health insurance to fit your health care needs and budget.
