Navigating the Affordable Care Act (ACA) marketplace can be challenging, especially with the variety of plans and options available. To help you make an informed decision, here are some common pitfalls to avoid when selecting an ACA plan.

1. Overlooking out-of-network costs

One of the most significant mistakes is not checking if your preferred doctors and hospitals are in-network. Out-of-network care can be substantially more expensive, leading to unexpected costs.

Tip: Always verify that your health care providers are in-network before selecting a plan.

  • You can use Priority Health's Find a Doctor tool to search for providers, pharmacies and other locations when shopping for a MyPriority® plan.

2. Ignoring prescription coverage

Assuming all medications are covered under any plan can lead to costly surprises. Each plan has a formulary, a list of covered drugs, which can vary significantly.

Tip: Check the plan's formulary to ensure your prescriptions are covered and understand any associated costs.

  • Every MyPriority plan comes with PriceMyMeds, which automatically gives you the lowest price available on drugs at your in-network pharmacy.

3. Underestimating total costs

Focusing solely on monthly premiums can be misleading. While a lower premium might seem attractive, it's essential to consider all the plan details, including deductibles, copayments and coinsurance.

Tip: Estimate how much you'll use the plan and calculate its total cost to gain a clearer understanding of your potential expenses.

  • MyPriority members have access to Cost Estimator and Coverage Check, so you can know the cost of care before you receive it and control out-of-pocket spending.

4. Misjudging health care needs

Not accurately assessing your health care needs can result in choosing a plan that doesn't fit your situation.

Tip: Reflect on your past health care usage and anticipate future needs to select a plan that provides adequate coverage.

  • MyPriority plans give you chronic condition coverage, with access to medical services, supplies and medications for just the cost of a copay or coinsurance, even before reaching your deductible.

5. Missing enrollment deadlines

Forgetting important dates can leave you without coverage. If you miss the Open Enrollment Period, you can't sign up until the following year, unless you qualify for a Special Enrollment Period.

Tip: Mark your calendar with Open Enrollment Period dates and set reminders to ensure you don't miss the deadline.

6. Neglecting preventive services

Many ACA plans cover preventive services at no additional cost, but these benefits are often underutilized.

Tip: Take advantage of free preventive services to maintain your health and catch potential issues early.

  • Priority Health has $0 preventive care on things like vaccines, annual physicals, cancer screenings and more. See our Preventive Health Care Guidelines for covered services.

7. Overlooking plan changes

Assuming your current plan hasn't changed can be a costly mistake. Plans can change their coverage details and costs annually.

Tip: Review any changes to your plan each year to ensure it still meets your needs.

  • An enrollment specialist from our award-winning team1 can help you understand plan changes and provide guidance on selecting the right plan.

8. Not considering financial assistance

Many people miss out on subsidies or cost-sharing reductions because they don't check for financial assistance.

Tip: See if you qualify for financial assistance to lower your premiums and out-of-pocket costs, even if you think you don't qualify.

9. Not making the binder payment

Don't forget to make the initial premium payment, which is required to activate your coverage. If you do not take the final steps in enrolling in a health plan, you could risk not being covered and having to pay out-of-pocket expenses.

Tip: Ensure you make the binder payment by the specified deadline to avoid delays or gaps in your coverage.

  • You have several options to make a payment with a MyPriority plan, including recurring EFT.

10. Choosing based on price alone

Selecting a plan solely because it's the cheapest can lead to inadequate health care coverage or difficulty finding an in-network provider.

Tip: Balance the cost of the plan you're considering against the health plan provider and the quality of coverage to ensure the plan effectively meets your health care needs.

  • MyPriority plans offer benefits that support your physical, mental and financial health, striking the right balance between saving money and staying healthy.

Get ready to shop

By avoiding these common pitfalls, you can make a more informed decision and find an ACA plan that best suits your needs. Remember, taking the time to research and compare plans can save you money and ensure you have the coverage needed.

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