Through ValuePenguin's tool you can compare rates for individual medical insurance plans based on your state of residence. Individual health insurance policies are plans that you buy for yourself and your family if you do not receive coverage through work or Medicaid.
Our tool allows you to quickly search for and evaluate health insurance plans online. Here, you have the ability to view plan terms and prices and compare the other crucial differences among the policies before enrolling on Healthcare.gov.
How to Compare Health Insurance Plans
All marketplace health insurance policies will have three different costs to compare: a premium, deductible, and out-of-pocket maximum.
When looking for the right health insurance plan you must understand and compare each of these policy components and then choose a policy that provides proper health coverage at an affordable cost. This involves looking at the different metal tiers (Catastrophic, Bronze, Silver, Gold and Platinum) and comparing each provider network (PPO, EPO, HMO and POS).
The premium is the price of health insurance and what you will pay to continue to be covered. Premiums for marketplace plans are a monthly payment that you will be billed for by the health insurer that you choose. When comparing health insurance plans, evaluate the premiums and calculate, based upon your income, which policies are affordable financially.
The deductible represents the amount of money you must spend before your health insurer will provide coinsurance or copay benefits. When viewing plan deductibles you will see an individual deductible and then a family deductible which is typically double the individual amount. Every time you use your health insurance and pay for a medical service, these expenses will count toward the deductible. Then, once it has been reached, the health insurer will pay a portion of any medical expenses you incur.
The out-of-pocket maximum is closely related to the deductible of a health insurance policy. It operates similarly in that as you spend your own money on medical expenses you will continue to work toward the out-of-pocket maximum. In between the deductible and out-of-pocket maximum, you would be eligible for coinsurance and copays. But once the out-of-pocket maximum is reached, all medical expenses you incur would be completely covered by your health insurance company.
Both the out-of-pocket maximum and deductible are essential to consider when evaluating the affordability of policies. Since you are responsible for all expenses before the deductible, if you choose a deductible that is too high and have a large medical expense, you may not be able to cover the cost of treatment. You should try to predict your medical expenses for the next year and choose a plan that will provide you with the most benefits possible, while being low enough that you could pay to reach the deductible.
How to Compare Metal Tiers of Health Insurance
When using our compare tool and browsing health insurance plans you will notice that policies are categorized by metal tiers. The metal tiers are differentiated by the amount you would pay for premiums, deductibles, out-of-pocket maximums, and coinsurance or copays.
In most states, there are five different metal tiers available for purchase: Catastrophic, Bronze, Silver, Gold and Platinum. Choosing the right health insurance plan will require you to identify which metal tier is best for your current health and financial situation.
Catastrophic and Bronze health plans have the cheapest premiums but the highest deductibles and out-of-pocket maximums. For this reason, Bronze and Catastrophic plans are most affordable for individuals who are in great health and do not expect to have large medical expenses during the year.
Silver metal tier plans are a middle ground policy with modest premiums and deductibles. These plans are best-suited for individuals or families with average health insurance needs and household income. The federal government also allows Silver health insurance policyholders to receive cost-sharing reductions if your household income falls below 250% of the federal poverty level. This benefit will allow you to pay less in coinsurance, copays and deductibles.
Gold and Platinum health insurance plans have the most expensive rates but the lowest deductibles available on the federal marketplace. When comparing these health insurance policies to those in other tiers, you should consider your family's health insurance needs for the upcoming plan period. If you expect a large number of medical expenses, like prescription drugs or surgeries, then choosing a Gold or Platinum plan with a low deductible could be a cost-effective and cheaper option, despite the higher premiums.
How to Compare Health Insurance Networks
A key aspect of health insurance that you should consider when comparing plans is the type of provider network each one offers.
Each health policy will be classified into one of four different network types: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) or Point of Service Plan (POS). The main factors that you need to consider when comparing networks are whether the insurer needs a primary care physician (PCP) for referrals and the level of expenses you are responsible for if you receive out-of-network coverage.
A PCP is a health care professional that is your first point of contact for health care. PCPs will provide you with basic care services and recommendations to see other specialist doctors if needed. If you choose a provider network that does not require a PCP, then you would be able to seek out care from specialists on your own instead of getting referrals.
|Access to Doctors and Providers||Yes||Yes||Yes||Yes|
|Deductibles and Premiums||Lowest||Lower||Average||Higher|
|Specialist Referrals Required||No||Yes||Sometimes||No|
Find ACA Plans in Your State
Every type of health insurance network has access to groups of doctors and providers but not all allow you to go outside that network and receive care. This can be important, because if you regularly see a specialist, then you may lose the ability to go to that care provider if they are out-of-network. For example, if you currently visit a specialist chiropractor, make sure the plan that you buy would cover any expenses of visiting that care provider. Similarly, if you previously owned health insurance and had a primary care physician that you preferred, make sure he or she is on the new plan's network before purchasing the policy.
Private Health Insurance and Short-Term Plans
If you have compared individual marketplace health insurance policies and concluded that these plans are not suited for your situation, or you aren't currently eligible to enroll, there are other options for health coverage you can consider: purchasing a private health plan or short-term policy.
Private health insurance is very similar to a marketplace plan, except you would purchase it directly through a health insurance company or broker. When compared to a marketplace medical plan, private health insurance policies have near identical premiums and deductibles and cover the same amount of essential benefits. However, you cannot get tax credits based on your income if you decide to purchase a private policy.
Alternatively, if you are looking for the cheapest option health insurance then you could consider purchasing a short-term health insurance policy. This is thin health insurance that does not include the same benefits as private or individual health insurance. For this reason, you should only consider short-term plans as an option if you miss open enrollment or are between jobs and need health insurance coverage.
Health Insurance Research & Advice
The Small Business Health Options Program, commonly called the “SHOP” Marketplace or exchange, was established under the Affordable Care... Read More
The most controversial provision of the Affordable Care Act is the adoption of the individual mandate, requiring all Americans to maintain... Read More
In 2014 residents across the United States will be required to purchase health insurance in one form or another or face tax penalties for... Read More
Everything you need to know about how the ACA subsidies work. Including eligibility, how they're calculated and any things you should be... Read More
The Affordable Care Act, will usher in multiple changes for Oregon residents. ValuePenguin compared costs of current health care insurance... Read More