Choosing a health plan is one of the most important decisions you'll make for you and your family. It can also be one of the most challenging. You're likely to come across a lot of terms and phrases that you haven't encountered before. That's why we've created this guide to help you compare health plans and choose the right one for your budget and health needs.
We'll go over Individual and family health plans, which are plans for people who are purchasing their own health coverage.
Visit the health plan Marketplace
One of the first steps you can take when choosing a health plan is to visit the Health Insurance Marketplace®.
When you shop and compare through the Marketplace, you'll have the opportunity to find the right plan for you. After entering some information about yourself, you can start comparing health plans. You can also find out if you qualify for a subsidy for your plan, which is determined by your household size and income. When you shop for MyPriority® plans, we'll check to see if you're eligible for federal subsidies.
Even if you're not eligible to select a health plan because it's not Open Enrollment Period (OEP), you'll be able to shop and compare once OEP begins. You can shop any time if you qualify for a Special Enrollment Period.
What is Open Enrollment Period?
Unless you have a qualifying life event you can only sign up for a new health plan during the Open Enrollment Period, which occurs every year between Nov. 1 and Jan. 15.
To have coverage begin on Jan. 1, you need to enroll between Nov. 1 and Dec. 15. Open enrollment continues through Jan. 15, with coverage starting on Feb. 1 for those who enroll between Dec. 16 and Jan. 15.
Keep in mind that before you can access your plan, you must complete the final step to enrolling, which is paying your initial premium.
After Jan. 15, individuals and families can only sign up for a health plan if they qualify for a Special Enrollment Period, which is typically a 60-day window to sign up for coverage. A Special Enrollment Period is only triggered by a qualifying life event. Learn more.
Terms to know when comparing health plans
HMO vs. PPO, POS and EPO
One of the first things to learn when comparing health plans is all the abbreviations you'll read about. Most health plans you search for will fall into one of four categories: HMO, PPO, POS and EPO. HMOs and PPOs are the most popular plan types.
- A Health Maintenance Organization (HMO) plan usually has a lower deductible and premium, along with fixed copays. You'll need to see a doctor in your plan's network with an HMO plan.
- A PPO is a Preferred Provider Organization plan. It will have larger premiums but lower copays. It also enables people with this plan to see out-of-network providers without referrals.
- A Point of Service (POS) plan costs a bit more out-of-pocket, due to higher premiums, but it will let you visit out-of-network providers.
- Exclusive Provider Organization (EPO) Plans have slightly higher premiums than HMOs and only work with in-network doctors, but they typically have bigger networks.
What about a high-deductible health plan with Health Savings Account?
A high-deductible health plan (HDHP) will have lower premiums, which are offset by high out-of-pocket costs. A Health Savings Account (HSA) can be used to pay for medical expenses. HSAs work like regular savings accounts, but you won't have to pay taxes on income that goes into it, interest your money earns, or expenses that you take out – if they are used for qualified medical reasons.
What does plan metal level mean?
Another term unique to comparing Individual and family health plans is the metal level: Bronze, Silver, Gold and Platinum plans. These levels represent how costs are split between the plan holder and the health coverage provider.
For example, with a Bronze plan, the individual might pay about 40% while the coverage provider pays 60%, resulting in lower premiums. In contrast, a Platinum plan will cover around 90% of expenses, leaving only 10% for the members, but these plans usually have the highest premiums.
In addition to those categories, there are also "catastrophic" health plans that are made for people under 30 who want to pay low premiums while protecting themselves against the medical bills they would receive if they fell severely ill or were significantly injured.