Choosing an insurance plan can be overwhelming – depending on where you live you could have dozens or even hundreds of choices. Fortunately, the Affordable Care Act (“Obamacare”) has standardized many of the features of the various plans out there, so for most people, the decision comes down to these four factors:
Monthly Premium: The amount you pay the insurance company each month.
Remember that you may qualify for a government tax credit, which will be paid up front and could significantly lower your premium. You can check whether you qualify on HealthSherpa.com by entering your zip code, family size and household income – no names or contact information required unless you decide to enroll.
Cost-Sharing: The amount you pay for deductibles, copays, coinsurance and out of pocket maximums.
These key components to the the cost of a plan are directly linked. Here’s some more context: You pay all your medical expenses until you spend your deductible amount. You and the insurance company then split your medical expenses with you paying the coinsurance percentage until you reach your out of pocket maximum. After that, the insurance company covers all of your medical expenses.
Note that if you are eligible for cost-sharing reduction, silver plans will have lower deductibles and out of pocket maximums. Our consumer advocates are available year-round to help you understand what this means for you-you can email, chat or call our team anytime.
Provider Network: The doctors, hospitals and other treatment providers that are covered by the plan.
Look for the handy “Details” link below any plan listed on HealthSherpa.com – this will link you to the insurance company’s website, where you can check which doctors and hospitals they cover. We recommend you also call your doctor’s office or favorite hospital and ask them to confirm the insurance plan is covered.
Drug Formulary: The drugs that are covered by the insurance plan, and how they are classified.
Helpful Hint: Look at the Summary of Benefits and Coverage
Every plan is required to have a standardized summary of benefits and coverage that explains the key characteristics of the plan in detail. You can easily find the summary of benefits for each plan as you are shopping on HealthSherpa.com – we recommend reading the summary before enrolling.