Comparing health insurance plans
How to compare individual and family health insurance plans
When buying a health insurance plan, there are a lot of things to consider. We’re here to help you learn the basics about health insurance plans and costs so you can find a plan that works best for you.
What to consider when comparing health insurance plan costs
When comparing plan costs, there’s more to think about than just your monthly premium. There are other out-of-pocket costs to consider as well.
Generally, the higher your premium, the lower your out-of-pocket costs. Out-of-pocket costs may include:
- Deductible – This is the amount you pay for covered medical care before your plan starts to pay. Before you meet your deductible, you’re responsible for all costs (unless otherwise noted). After you meet your deductible, your plan starts to chip in.
- Copays – These are flat fees you pay each time you receive a service or procedure.
- Coinsurance –This is a percentage of the total cost you pay for care, and your plan covers the rest.
- Out-of-pocket maximum – This is a set amount and the most you’ll pay in a year. When you reach your out-of-pocket maximum, your insurance takes care of all remaining medical costs.
In addition to understanding health insurance terms, it’s also a good idea to check if you may be eligible for extra savings – like tax credits. You can take advantage of these opportunities to lower the cost of your plan by shopping for coverage on your state’s health insurance marketplace (also called an exchange).
Most plans have three levels: gold, silver and bronze. Plan levels are based on monthly premium costs and how often you expect to use your plan.
When choosing a plan level, there are a lot of factors to consider: Do you plan to visit the doctor frequently or just a few times a year? Would lower monthly premiums, but higher care costs, fit your budget? Whether or not you’ve purchased insurance before, think about how you see yourself using your plan as you compare plan levels. Below, we’ll cover the basics.
With gold plans, your insurance carrier pays around 80% or more of your costs, and you pay at most the remaining 20%. Monthly premiums tend to be higher with gold plans. But when you need care, you’ll pay less for it than with other plan levels.
A gold plan might work for you if:
- You have health conditions that need ongoing management and anticipate needing richer insurance coverage
- You expect your family to visit the doctor frequently
A CSR is a discount that lowers costs for copayments, coinsurance and deductibles. It’s available only with silver-level plans on the marketplace.
A silver plan might work for you if:
- You’re not sure what your health care needs will be, but you want more than basic coverage
- Your family visits the doctor a few times per year
With a bronze plan, your insurance carrier pays about 60% of your costs, and you pay the remaining 40%. While this level typically has the lowest monthly premiums, you’ll pay more than the other levels when you need care.
A bronze plan might work for you if:
- You only want protection from a serious unexpected illness or injury
- You’re looking for a more budget-friendly option because you don’t expect to visit the doctor very often
What to remember about insurance plan levels
Here’s a summary of the most important takeaways about insurance plan levels. Keep these things in mind as you start to shop different plans:
|Your monthly premium||Higher||Moderate||Lower|
|Your costs when you get care||Lower||Moderate||Higher|
|Could work for you if||You think you’ll use your health insurance a lot||You’re not sure how much you’ll use your health insurance, but you want to be prepared||You don’t think you’ll use your health insurance very much (like only in an emergency)|
More plan types
A Catastrophic plan is for people under 30 years old, or people who are over 30 years old and have an