Last updated: September 6, 2024

How do I pick a plan on the Marketplace?

Choosing a health insurance plan can be complicated. HealthCare.gov has some helpful tips to make choosing a plan simpler. Here are some key things to know before picking a plan:

-There are 4 metal categories of health insurance plans on the Marketplace: Bronze, Silver, Gold and Platinum. There are also some called Catastrophic plans, but only certain people can buy those.

Metal categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care.

For example, with a bronze level plan, you pay the lowest monthly premium, but you pay more when you go to the doctor. With a platinum level plan, you pay the highest monthly premium, but you pay less when you go to the doctor. Silver and gold plans both fall in the middle. You will need to think about how often you go to the doctor and how many prescriptions you regularly take to decide which metal category is right for you.

Below is a picture that shows how much your insurance company pays compared to how much you pay for each metal level:

A few more tips:

-When choosing a plan, it’s a good idea to think about your total health care costs, not just the bill (the “premium”) you pay to your insurance company every month.

Other amounts, sometimes called “out-of-pocket” costs, have a big impact on your total spending on health care – sometimes more than the premium itself.

– There are different types of Marketplace health insurance plans that have different provider networks. Some types of plans limit which doctors you can go to or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others will help pay for more of the costs for seeing providers outside the plan’s network.

Can I get a discount on my health insurance in the Marketplace?

Many people are eligible for a discount on their monthly premium (e.g., monthly insurance bill) when they buy health insurance through the Marketplace. These discounts are called premium tax credits. Check here to find out if you qualify for premium tax credits.

Many people with lower incomes are also eligible for a discount on some out of pocket costs (such as co-pays, deductibles, and out of pocket limits). These discounts are called cost sharing reductions (CSRs). Check here if you qualify for cost sharing reductions.