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What is the Best Individual Health Insurance?

Selecting the best individual health insurance plan can be complicated. Knowing just a few things before you compare health insurance plans can make it easier.

The Metal Categories

Plans in the Marketplace are offered in 4 “metal” categories: Bronze, Silver, Gold, and Platinum. (Catastrophic health insurance is also available to some persons.)

The Right Metal Category

Bronze

• Bronze has the Lowest monthly premium
• Highest costs when you require care
• Bronze plan deductibles — the amount of medical expenses you pay yourself before your insurance plan begins to pay.
• The best option if You need a low-cost way to protect yourself from worst-case medical scenarios, such as severe sickness or injury. Your monthly premium will be low, but you will have to pay for most routine care yourself.

Silver

• Moderate monthly premium
• Moderate costs when you require care
• Silver deductibles — the expenses you pay yourself before your insurer pays anything — are usually lower than those of Bronze plans.
• The best option if You qualify for “additional savings” — or, if not, if you’re ready to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.

Gold

• High monthly premium
• Low costs when you require care
• Deductibles — the number of medical expenses you pay yourself before your carrier pays — are usually low.
• The best option if you are ready to pay more each month to have more costs covered when you get medical treatment. If you require a lot of care, a Gold plan could be a good value.

Platinum

• Highest monthly premium
• Lowest costs when you receive care
• Deductibles are very low, meaning your plan begins paying its share earlier than for other types of policies.
• Best choice if: You usually require a lot of care and are willing to pay a high monthly premium, knowing nearly all other expenses will be covered.

Your Total Costs for Health Care

When selecting a health insurance plan, it’s a good idea to think about your total healthcare costs, not just the bill (the “premium”) you pay to your carrier each month.

Other amounts, sometimes known as “out-of-pocket” costs, significantly affect your total spending on health care – sometimes more than the premium itself.

Outside your monthly premium: Deductible and out-of-pocket costs

• Deductible: The amount you pay to spend for covered health services before your insurance company pays anything (except free preventive services)
• Copayments and coinsurance: Payments you make every time you get a medical facility after reaching your deductible
• Out-of-pocket maximum: The most you have to pay for covered services in a year. After you attain this amount, the insurance carrier pays 100% for covered services.

Types of Health Insurance Plan & Network

There are different types of Marketplace health insurance plans intended to meet different needs. Some forms of plans restrict your provider picks or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of expenses for providers outside the plan’s network.

Categories of Marketplace Plans

Depending on how many plans are provided within your area, you may find plans of all kinds at each metal level – Bronze, Silver, Gold, and Platinum.

Some examples of plan kinds you will find in the Marketplace:

• Exclusive Provider Organization (EPO): A managed health insurance plan where services are covered if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
• Health Maintenance Organization (HMO): A kind of health insurance plan that typically limits coverage to care from doctors who work for or contract with the HMO. It typically won’t cover out-of-network care except in an emergency. An HMO may necessitate you to live or work in its service area to be qualified for coverage. HMOs often offer integrated care and focus on prevention and wellness.
• Point of Service (POS): A form of plan where you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. POS plans necessitate you to get a referral from your primary care doctor to see a professional.
• Preferred Provider Organization (PPO): A kind of health insurance plan where you pay less if you utilize providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an extra charge.

Resources and References:

• How Point of Service Plan Works
• Bronze Health Insurance Coverage
• Platinum Health Insurance Features