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How To Choose A Health Insurance Plan

What To Know When Choosing A Health Insurance Plan


Selecting a health plan that’s right for you and your family is a big decision. If your job doesn’t provide health insurance, you’ve recently lost health coverage, or you’re currently unemployed, you can shop for an individual health plan on the Health Insurance Marketplace, established under the Affordable Care Act (ACA).

Marketplace health insurance plans are organized into four categories: Bronze, Silver, Gold, and Platinum. Each plan differs in how you and your insurance provider share the overall cost.

Plan Bronze Silver Gold Platinum

What Your Plan Pays 





Your Cost 





Three Things To Consider When Choosing A Health Insurance Plan


  1. Understand plan types. Health plans can differ in cost, coverage, and access to doctors and specialists.
    • Health Maintenance Organization (HMO): HMOs limit coverage to select health providers contracted with the HMO company and often require a referral from your primary care doctor to see a specialist. If you choose to see a doctor outside of the HMO network or without a referral, you may be responsible for the costs, unless it’s a medical emergency.


    • Preferred Provider Organization (PPO): A PPO is a health plan with a “preferred” network of providers in your area and does not require a primary care provider (PCP) referral to see a specialist. If you choose to see a doctor outside the preferred network, you’ll generally pay a larger part of the bill as opposed to using an in-network provider — but most plans will still cover a portion of the costs.


    • Exclusive Provider Organization (EPO): An EPO is a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are usually less expensive than a PPO. Like a PPO, you won’t need a referral to get care from a specialist. But similar to an HMO, you’ll be responsible for paying the costs for seeing a doctor outside of the plan’s network. An EPO is a good option if you want to see specialists without a PCP referral.


      Compare HMOs, PPOs, and EPOs:


      HMO : Lowest premiums—Highest out-of-pocket costs for out-of-network providers

      • Only in-network providers and emergency visits are covered
      • Select provider options
      • Referrals needed for specialists


      PPO : Higher premiums—Lower out-of-pocket costs for in-network providers

      • Out-of-network providers are accepted, but cost more
      • More provider options
      • No referrals needed for specialists


      EPO : Lower premiums—Higher out-of-pocket costs for out-of-network providers

      • Only in-network providers and emergency visits are covered
      • Select provider options
      • No referrals needed for specialists


  1. Compare provider networks and costs. It’s a good idea to compare networks, premiums, and out-of-pocket costs.
    • Networks: You’ll get more out of your insurance plan and save money by selecting doctors in your plan’s network. If you choose to see an out-of-network doctor, your visit costs may not be covered.


    • Premiums: Premiums are your monthly payments for health insurance coverage. Typically, the more coverage you have, the higher your monthly premium will be.


    • Out-of-pocket costs: Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services. Out-of-pocket costs are usually more when you see an out-of-network doctor.

    If you’re concerned you can’t fit health insurance into your budget, check if you are eligible for a health insurance subsidy, which is financial help from the government to pay for your healthcare coverage. If you qualify, you may be able to lower or completely eliminate your premium.


  1. Determine the health plan benefits you need. Ask yourself these questions to narrow down the insurance type that works best for you.
    • If you currently have a preferred primary care doctor, is that doctor included in your potential plan’s network?


    • Do you mind seeking referrals from your primary care doctor for specialist visits?


    • Are the prescription drugs you regularly use covered by the plan?

    While looking at your health insurance options, you may also want to consider dental and vision coverage. All Marketplace health plans include dental and vision benefits for children and some plans may provide coverage for adults.


    If the medical plan you select does not include dental and vision coverage, Anthem offers stand-alone dental and vision plans for comprehensive health protection.



Need Help Navigating Marketplace Plans?


No matter what plan you select, you’ll benefit from the experience of a company that can help you confidently navigate the healthcare system. Anthem is here to assist you in comparing Marketplace plans, costs, and network types quickly and easily, plus tailoring your health insurance to fit your needs and budget.


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