Your total costs for health care: Premium, deductible & out-of-pocket costs
When choosing a plan, it’s a good idea to think about your total health care costs (including the premium, deductible, and copayment/coinsurance amounts), the health and drug services you'll use, the health plan category that works best for you, and plans with easy pricing.
Think about a plan's deductible and copays, not just the premium
In addition to a plan’s monthly
The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit.
Refer to glossary for more details.
, the
Your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.
Refer to glossary for more details.
you pay when you use services have a big impact on your total health care spending.
Your total costs for the year include your plan’s:
- Monthly premiumx 12 months: The amount you pay to your insurance company each month to have health insurance.
- Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)
- Copayments and coinsurance: Payments you make to your health care provider each time you get care, like $20 for a doctor visit or 30% of hospital charges.
- Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
Estimate the health and drug services you’ll use
Think about the health services and prescriptions drugs your household usually gets. Then, estimate the services you’re likely to use in the year ahead.
Get estimated total yearly costs when you preview plans & prices
- Enter some basic information (like ZIP code, household size, and income) when asked. Then, selectView plans.
- SelectAdd yearly coston any of the plans listed.
- Pick the level of care you expect to use this year— low, medium, or high use.
- SelectSave and continueto get yourEstimated total yearly costsfor each plan listed.
Note:Your actual expenses will vary, but the estimate is useful for comparing plans’ total impact on your household budget.
Pick a health plan category that works for you
The Marketplace has 4 health plan categories to help you compare plans: Bronze, Silver, Gold, and Platinum. They’re based on how you and the plan share the costs for care you get.
Generally, categories with higher premiums (Gold, Platinum) pay more of your total costs of health care. Categories with lower premiums (Bronze, Silver) pay less of your total costs. (But see the exception about Silver plans below.)
So how do you find a category that works for you?
- If you don’t expect to use regular medical services and don’t take regular prescriptions:You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.
- If you qualify for extra savings ():Silver plans may offer good value. If you qualify, your deductible will be lower and you’ll pay less each time you get care.But you get these extra savings only if you enroll in Silver.If you don’t qualify for extra savings, compare premiums and out-of-pocket costs of Silver and Gold plans.Check if you qualify for extra savings.
A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
Refer to glossary for more details.
- If you expect a lot of doctor visits or need regular prescriptions:You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.
Consider plans with easy pricing
Marketplace plans markedeasy pricinginclude some benefits before you reach the deductible. As soon as coverage starts,you’ll pay only a copayment for:
- Doctor and specialist visits, including mental health
- Urgent care
- Physical, speech, and occupational therapy
- Generic andmostpreferred drugs
And, this may help you compare easy pricing plans because they have thesame out-of-pocket costswithin their health plan category, like:
- Deductibles
- Out-of-pocket maximums
- Copayments/coinsurance
Compare only plans with easy pricing when you shop for coverage
- When viewing plans, selectAdd filters.
- Pick a Health plan category (Bronze, Silver, Gold, or Platinum). Then, selectwith easy pricing.
Once you apply this filter, only plans with easy pricing will appear for the category you picked.
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