Health insurance is a way to pay for care when you need it. It’s important to have coverage so you can avoid expensive out-of-pocket costs if you or your family gets sick or injured. Health insurance helps pay for medical expenses, like doctor visits, hospitalizations, and surgery. It also covers preventive services, like annual physicals and screenings. Most people can get health insurance through their employer, the Marketplace, or Medicaid. You may also be able to buy coverage directly from an insurer or through the private market. The type of health insurance you choose depends on your needs and budget.
There are 4 types of health plans in the Marketplace: Bronze, Silver, Gold, and Platinum. Each plan has different benefits, deductibles, copayments, and premiums. The Marketplace compares each plan’s cost-sharing to help you find the right one for you.
To make it easier to compare, the Marketplace organizes plans by the level of coverage they offer. This includes a catastrophic coverage plan, which has the lowest monthly premiums but the highest out-of-pocket costs when you need care.
The types of plans available in the Marketplace are Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Private Fee-for-Service Plan, and Exclusive Provider Organization (EPO). PPO and HMO plans have networks of doctors, hospitals, pharmacies, and other health care providers that the plan works with to help you save money on your health care costs. If you want to use a provider that isn’t in your network, the plan may still cover the visit at a higher cost-sharing rate or may require a referral from your primary care physician before paying for the service.
EPO and PPO plans can have a network of doctors, but they also allow you to see doctors outside the network at a higher cost-sharing rate or without a referral from your primary care physician. For both of these types, it’s important to consider the long-term cost of going out-of-network versus staying in-network.
To ensure you’re getting the best value, you should compare all the short-term and longer-term costs of a plan. These include the monthly premium, deductible, and copayments. You should also pay attention to the annual out-of-pocket limit, which is the maximum amount you’ll be responsible for in a year, including the deductible, copays, and coinsurance. Most people never reach this limit, but it’s good to know if you need to plan for a high out-of-pocket amount in case of an unexpected health care need. Also, be sure to compare any limits that are included in the plan, like room rent, ICU room rent, AYUSH coverage, domiciliary treatments, etc.