How to Pick the Right Marketplace Insurance Plan: HSA, HDHP vs PPO & More!

Your health insurance is probably one of the most important decisions you make on a yearly basis. Unfortunately, it can also be the most confusing! Check out this video to learn how to pick the best Marketplace Insurance Plan on Healthcare.gov.

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Marketplace Plans are a great option for comprehensive coverage, but there are so many decisions to make:
1. What's the best health insurance for self employed people?
2. HDHP vs PPO
3. HDHP and HSA (Health Savings Account
4. Unemployment and Tax Credits

There are many factors to take into consideration when choosing a health insurance plan but basically it boils down to needs vs budget.

It’s actually much easier to understand our budget because it’s a hard number. There are a few costs you need to take into consideration:
Monthly Premiums
Deductibles
Cost Sharing Expenses (copays and coinsurance)
Out of Pocket Maximums

Your monthly premium is the amount you pay out of pocket to keep your insurance active. If you qualify for a tax credit, this is where you will see those monthly savings. The are four “metal levels” of coverage:
Bronze
Silver
Gold
Platinum

Generally speaking, bronze will have those lowest monthly premiums and platinum will have the highest. If you qualify for a tax credit, it will be applied to your monthly premium regardless of which plan you choose.

Then there is the deductible (the OOP before cost sharing) Under the ACA, all marketplace insurance plans must cover services deemed essential benefits before you meet your deductible. So for these services, you may have a copay or coinsurance as opposed to being responsible for the entirety of the cost even before your deductible is met. Some benefits are also covered at no cost.

Then there is the cost sharing aspect. Once you’ve met your deductible (or before if it is an “essential benefit”) you will pay for a portion of the cost and your insurance will pay for a portion. Even though there may be a pattern in the premiums and deductibles, the cost sharing is how the plans are delineated.

Bronze: 60/40
Silver: 70/30
Gold: 80/20
Platinum: 90/10

Finally, there are out of pocket maximums or limits. This is the max that you will pay out of pocket before your insurance covers 100% of the costs. In 2021, the max for an individual is $8,550 and for a family it’s $17,100. Your plan may offer lower limits and that will be indicated in the plan overview.

You’ll also need to identify your health needs.
1. How often do you and your family visit the doctor?
2. Other than the free services offered by marketplace plans, how often do you make use of the other listed “essential benefits”?
3. Do you have any conditions that require more frequent visits or in depth tests?
4. Do you have any specialty medical needs that might require a plan with more elaborate benefits?
5. Do you have any monthly prescriptions?


You’ll also need to understand the plan itself to determine which plans might best serve your needs:
1. Do you need the flexibility of a PPO? Or can you work with an HMO or EPO?
2. Do you have a network of doctors and hospitals you prefer? Do they accept your plan?

Picking an inexpensive plan may seem like a good idea, but if the doctors and benefits that you need to utilize are not covered by that plan, it won’t do you much good.

Additionally, picking a plan with a lower premium may seem budget friendly, but if you end up having to pay a larger deductible or larger copays for frequent visits, it may not actually be financially advantageous.

That may seem like a lot to take into consideration, but it doesn’t even end there! You'll also need to think about:
1. Additional benefits such as dental and vision. Will you purchase a separate plan?
2. HSAs & HDHPs
3. Premium tax credits

If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-410-0344 or https://ihealthbrokers.com/


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Essential Benefits on Healthcare.gov
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