How can I know I'm purchasing the right health insurance policy?
Who is this for?
This information will help if you're shopping for individual health insurance and want to know how to pick the right plan.
The Affordable Care Act means health insurance plans for individuals and families have more in common, like metal tiers and essential health benefits. But you still have some decisions to make when finding the right plan for you and your family.
A good way to start is to think about how much you use your insurance. If you go to the doctor a lot, you may want a plan with higher monthly payments but lower out-of-pocket costs. It makes your medical expenses more predictable.
If you're healthy and rarely go to the doctor, you might want a plan with lower monthly payments. But lower-priced plans have higher out-of-pocket costs. That means you'll pay more up front when you need medical care.
How it works: meet Mike and Lisa
Mike and Lisa are both self-employed, so they buy their own health insurance. Mike's married with three teenagers all involved in sports. Between minor injuries, typical illness and managing Mike's mild high blood pressure, the family goes to the doctor and fills prescriptions frequently. Lisa is 33, single and has no children. She's rarely ill and exercises regularly. Last year her only medical expenses were a doctor bill and prescription when she got bronchitis. Let’s look at some health plan options for them.
With an active family, Mike has a lot of expenses. So he's concerned about the monthly cost his health plan. If he chose Blue Cross Bronze Select, his monthly payment would be quite a bit lower than Blue Cross Gold Select Extra. But that’s not the whole story. Mike should also think about his out-of-pocket costs: what he has to pay when he uses his coverage. Here’s how the two plans compare.
|Blue Cross Bronze Select||Blue Cross Gold Select Extra|
|Office visits||$30 after deductible||$20 copay any time|
If he chooses Bronze Select, Mike will pay all his medical and pharmacy bills until they total the plan’s $11,900 deductible. Since illness and injuries don't happen regularly, other than his monthly payment Mike won’t know what his medical expenses might be each month. One month everyone could be healthy; the next month they could rack up $2,000 in medical expenses.
With Gold Select Extra, his deductible is only $1,000. Then his plan starts sharing up to 80 percent of the cost. He also doesn’t have to pay his deductible first to get low doctor visit and pharmacy copays.
Although his monthly payment will cost more, Mike is probably better off with Gold Select Extra. Here’s why.
- He'll quickly meet his deductible so his plan will start sharing costs much sooner.
- His coinsurance will be lower.
- His costs will be more predictable.
And if Mike is eligible for a subsidy, he’ll get help paying for his plan.
Lisa could also get lower monthly payments by choosing a bronze plan with a high deductible. In fact, she seems like a great candidate. Why pay for something she doesn't use? But what Lisa doesn't know is that in a few months she won't feel so good. After doctor visits and tests, she'll be diagnosed with diabetes. Now she has a health condition to manage—and a lot of bills to pay on top of her premium because she has to meet her high deductible before her insurance starts sharing costs.
What's right for you?
Everyone's life is different. But no one is immune to illness and injury. That's why there's health insurance. A good approach is to get a plan that balances the lowest out-of-pocket expenses with a monthly payment you can afford. That could be the right plan for you.
A subsidy can help make your health insurance more affordable. You can use our subsidy estimator to see if you're eligible. Then take a look at the individual and family health insurance plans to see what kind of plans are available.