7 tips to choose the right Marketplace plan

Everyone’s health care needs are different. Knowing how much you’ll pay for your premium, deductible and out-of-pocket costs when you actually get care will help you decide which Affordable Care Act (ACA) Marketplace plan might fit you (and your family) best.

Before you speed through your health coverage options, ask these 7 questions to find the best plan for you. We’ll help you answer each one during our shopping and enrollment process.

You’ll pay your monthly plan premium regardless if you use your benefits that month. Think of it like any other monthly insurance payment. Be sure to pick a plan with a premium that fits your budget. Some plans even have a $0¹ premium.

You’ll want a plan that matches the type of care you think you’ll need, as well as how often you see your doctor. For example, if you typically only see your doctor for your annual checkup, you may want to consider lower-cost plans that don’t offer a bunch of bells and whistles (like Bronze plans). On the other hand, if you’re managing a few chronic conditions and regularly see your doctor, check out plans that offer comprehensive coverage for doctor visits (like Gold plans).

If you’re looking for plans that offer financial help (subsidies), you’ll want to enroll in a Silver plan. Marketplace plans in the Silver metal level are the only ones that offer these additional cost-savings. During your enrollment process, you’ll find out if you qualify for financial help. If you do, focus on those Silver plans to find the one you like best.

It’s important to make sure the doctor(s) you want to see are covered in your plan’s provider network. Your plan’s network includes doctors, clinics and hospitals that have worked with your health plan to offer you care at a lower cost. Keep in mind, if you see a doctor outside your plan’s network, you’ll pay more for your visit.

Just like with your favorite doctors, it’s important to make sure your prescription meds are covered in your plan’s drug formulary. This list of medications shows which prescriptions you can get with your plan at a lower cost. Anything that’s not listed on the formulary will likely cost you more out-of-pocket.

When you have questions or concerns about your health plan, having a team you can rely on gives you the convenience you deserve. Most plans have a call center for member questions. Some plans have a variety of support teams tailored to specific needs, like a nurse line.

All plans on the health care Marketplace are required to offer essential health benefits. In addition, many plans offer lots of exciting benefits that go above and beyond these requirements, as well as member perks and discounts.

Use this sheet to keep track of some of this important information as you shop around.