Choosing an Affordable Care Act (ACA) health plan through the marketplace can be confusing. Start by looking at the plan’s provider network.
A network is a group of doctors and other providers across multiple specialties that have a contract to provide healthcare services to members of a health plan.
You want to make sure the doctors and other care providers you see are in the network before picking a plan. Generally, less costly plans have fewer doctors and other health providers in their networks.
You should also look at the plan’s formulary, which is a list of prescription drugs that are covered by a plan. If you take medicines, make sure the:
- Pharmacy (Rx) benefit covers the medicines you take.
- Pharmacy you use is in-network.
Formulary – A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list. (source: https://www.healthcare.gov)
If you take generic medicines, look for plans with tiers. Tiers are groups of drugs that have different costs depending on the tier they are in. Lower tiered drugs will cost you less than drugs in a higher tier.
Tiers – The multiple levels of coverage based on the type of usage of the medication. Each tier will have a defined out-of-pocket cost that the patient must pay before receiving the drug (source: 2019 Patient Advocate Foundation)
Compare Total Cost to You
Don’t look at just the monthly premium cost—the amount you pay each month for health insurance. You should also look at the:
- Deductible—the amount you must pay before your insurance pays anything.
- Copayments—the set amount you pay for healthcare visits, medicines, and supplies.
- Coinsurance costs—the percentage of costs you pay after your health plan has paid its share.
Download Health Insurance Terms to help you understand important insurance terms.
You could be eligible for a subsidy to pay for some of your monthly premium based on your household income. Use this calculator to estimate your monthly subsidy.
I’m Ready to Enroll, What Now?
To get a free quote, you just need your date of birth.
Click here to enroll now.
- If you enrolled with American Exchange last year and have a state-specific log in, go to that page to access your account.
Be sure to upload documents if you are asked for them (see above list).
Download our Enrollment Checklist to help you gather all the information you need to enroll.
Our ACA-licensed enrollment team can answer your questions, walk you through the enrollment process, and help you pick the plan that is right for you and your family.
Our extended open enrollment hours are:
- Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time
- Saturday 8:00 a.m.to 5:00 p.m.
- Sunday 12:00 p.m. to 5:00 pm.