How to Choose a Plan on Healthcare.gov in 4 Easy Steps

Kat Tretina

December 6, 2017  •  3 Minute Read

Insurance

If you’re struggling to pay your bills, an expensive health insurance policy is probably last on your list of priorities. But, you may not be able to afford to go without insurance. Medical debt is one of the leading causes of bankruptcy. A single car accident or medical emergency can wipe out your savings.

Even if you’re healthy (and lucky), going without insurance isn’t such a cheap option anymore. Thanks to the Affordable Care Act, the government will charge you a $695 penalty if you don’t have adequate insurance.

You can prevent paying the penalty and protect yourself in an emergency by signing up for a plan on healthcare.gov by December 15. However, understanding insurance policies and choosing a plan can be overwhelming. Here is everything you need to know to make an informed decision.

1. Decide What’s More Important: Low Premium or Low Deductible

When you’re comparing plans, it’s important to understand some basic terms. Your insurance premium is what you pay each month to your insurer, like a subscription fee. Your premium stays the same every month even if you don’t visit a doctor or use your insurance during that time.

Your deductible is what you have to pay yourself before your insurance kicks in for medical care. For example, if your deductible is $1,000 and you undergo $1,500 of tests, you are responsible for $1,000 of the bill and your insurance covers the remaining $500.

Deciding which is more important to you — a low premium or low deductible — is key to choosing a plan. A plan with a low deductible will have a much higher premium than a plan with a high deductible. If you’re relatively healthy and rarely need medical care, a high deductible plan may be a smart option.

2. Choose a Health Plan Tier

Plans offered through Healthcare.gov fall into four tiers: bronze, silver, gold and platinum. The tier you choose doesn’t impact the quality of care you receive; it only reflect the cost. For example, high deductible plans that are cheaper will be bronze plans, while $0 deductible plans that are expensive will be in the platinum tier.

Many healthy young people can choose a bronze or silver plan for affordability and be sufficiently covered. But if you have ongoing health issues or a condition that requires regular care, you may want to consider a higher tier plan to limit how much you pay out of pocket.

For example, under a platinum plan, insurance companies cover 90 percent of your health costs and you are responsible for just 10 percent. If you need regular treatments or surgery, a platinum plan may be cheaper in the long run because the insurance starts covering you earlier.

3. Find Out What Doctors You Can Visit

When reviewing plans, you’ll see a lot of acronyms like HMO or PPO. These acronyms affect what doctors you can see under each plan.

• HMO: HMO plans limit you to doctors within a certain network. If you see a doctor outside of the HMO network, your insurance won’t cover you and you’ll have to pay for the visit yourself.

• PPO: You have more choice with a PPO, which is why PPO plans tend to be more expensive than HMO plans. With this type of plan, you’ll pay less to see in-network doctors, but you can opt to see doctors and specialists outside of the network if you choose, without a referral.

If you have a doctor currently that you like and want to keep, you need to check to see if your doctor is “in-network” in each health plan offering.

4. Where to Go For Help

If you’re confused and need assistance choosing a plan that’s right for you, you can call 1-800-318-2596 to speak to someone 24 hours a day, seven days a week. You’ll be connected with a representative who can help you through the process.

If you’d prefer to get in-person help, you can use healthcare.gov’s “Find Local Help” tool to find area organizations that have insurance navigators and assisters. These organizations help you understand the intricacies of each plan and their costs so you can pick a plan that works for your needs.

With the Open Enrollment deadline quickly approaching, it’s important to take action now to prevent owing a penalty or going without coverage. By taking the time to research plans and reaching out for help if you need it, you can be appropriately covered in 2018.