Plans are organized via four “metal” tiers. In general, bronze plans tend to have the highest deductibles and platinum plans the lowest. In picking a plan, you should consider both the premium and how much you would have to pay in cost sharing if you became ill. Plans also differ according to which doctors, hospitals and drugs they include. In some cases, plans may offer special extra benefits, like free access to telemedicine. Depending on your needs, you may want to research those details in addition to considering the dollars involved.
Consider all of the choices carefully. Because of a quirk of policy, in some parts of the country more generous gold plans may turn out to be cheaper than less generous silver ones.
Most people without insurance will qualify for subsidies.
The sticker price for insurance can be high in many markets, but if you earn less than 400 percent of the federal poverty level — or around $51,000 a year for a single person or $105,000 for a family of four — you can quality for subsidies that limit your premium for certain plans to a set fraction of your income. Make sure you enter your income as you shop so you can see the prices that are relevant to you. Surveys show that some uninsured people don’t buy coverage because they assume they can’t afford the sticker price. This is why looking up your price with subsidies is important.
For people with incomes below around $31,000 for a single person or $65,500 for a family of four, subsidies will also lower your deductibles and co-payments if you buy a plan in the silver category.
If you don’t qualify for subsidies, there may be additional choices.
Many shoppers who earn too much to qualify for help paying their premiums may be better off with health plans sold directly by insurance companies. Those plans will not be listed on healthcare.gov. A broker or an online brokerage can help you find additional options. You may also be able to find offerings by contacting insurance companies directly or visiting their websites. Finding such plans will take more work, but may yield a better deal.
But be careful: Once you’re shopping outside of healthcare.gov, not all the plans will be held to the same standards, and there are sketchy options out there that don’t offer comprehensive coverage. Plans that adhere to all the Affordable Care Act rules, which include a standard set of benefits, and are sold to people regardless of prior illness, are called “qualified health plans.”
There are also “short-term” plans. These tend to be cheaper but can have more benefit holes, and they may not be offered to everyone. Some organizations known as health sharing ministries offer products that sound like health insurance but are actually religious fund pooling groups that lack the same kind of guarantees on paying for your care if you become ill. Avoid companies that cold-call your phone offering health insurance; they’re often scams.