How to Find the Best Health Insurance Plans on the Marketplace

Health insurance is one of the most significant financial investments that many of us make. In exchange for an up front premium, the health insurance company promises to pay for some or all of our medical costs should we ever need them.

The actual costs of providing care for an individual are typically more than the premium paid to cover the cost, so most plans have a range of other charges such as copayments, deductibles and coinsurance that capture the amount you pay each time you access health care services. In addition, a health plan may have special rules that dictate whether certain treatments are covered or not, or which providers you can visit and who is in-network or out-of-network.

All these different components make it hard to compare apples to apples when choosing a health insurance plan. It’s important to consider all these different factors when selecting the right plan for you and your family.

A good way to start is to look at a plan’s Summary of Benefits and Coverage (SBC) which is available on the Marketplace website for each individual or family. This will provide a list of the benefits for each plan, including coverage for preventive health services, prescription drugs and hospitalizations. It will also identify any annual limits, copayments or deductibles.

In addition, if you have a list of preferred health care providers you want to keep, it’s important to check that they are in-network for each plan you are considering. You can use the search feature on the Marketplace to do this and eliminate any plans that don’t have your doctors in-network.

Finally, it’s always a good idea to look at the annual out-of-pocket maximum, which is a limit on how much you’ll have to pay in a year through copayments, deductibles and coinsurance for your health care before the insurance company begins to pick up 100% of the tab. Many people never reach this limit because they have a combination of good luck with their health, low utilization and the fact that their chosen providers are in-network.

While it’s possible to live without health insurance, most of us prefer to have a safety net in case something goes wrong. This is why we all invest so heavily in it through direct personal expenditures, forgone wages and tax policy. For most, it’s worth the peace of mind and financial security that comes with it. But it’s important not to forget that there are a large number of individuals who are uninsured or underinsured. They often face barriers to receiving care such as lack of transportation, illiteracy and linguistic and cultural differences. These obstacles should refocus our attention on the fundamental challenges and needs of those who do not have the benefit of health insurance. This is where we can begin to make real progress in addressing health disparities.