How to choose health insurance

Compare your health insurance options

It’s important to know how to compare ACA health insurance plans to find one that matches your health needs and budget. Navigating the benefits of plans available in your area is key to finding the best option for you and your family. This section breaks down the types of costs you'll encounter, such as premium, deductible, and other out-of-pocket expenses. Additionally, if you can see the differences in the health plan network, coverage levels, and benefits between plans, it will help you make an informed decision.

Understanding Wellpoint Individual and Family HMO and POS plans

• HMO stands for “health maintenance organization” plans. Typically, HMOs have the lowest monthly premium, and care is limited to in-network providers. Wellpoint Individual & Family HMO plans will assign a primary care provider (PCP), or you can choose your own. But unlike other HMO plans, you do not need a referral to see a specialist when you choose a Wellpoint HMO plan.
  
  
• POS stands for “point of service” plans and are a hybrid between an HMO and a PPO (preferred provider organization) plan. With a POS plan, you have the flexibility to receive care from both in-network and out-of-network providers. However, in some cases, when you receive care from in-network providers, you’ll pay less out-of-pocket.  Wellpoint POS plans will assign you a PCP or you can choose your own, but you do not need a referral to see a specialist.

There are many ACA-compliant health insurance options. When it comes to knowing what to look for in a plan, it's important to explore benefits beyond the monthly premium. You’ll also want to consider the coverage details. This includes the deductible, out-of-pocket maximum, copays, and coinsurance. If you are wondering how to choose health coverage, one approach is to look at plans side by side. This can help highlight differences in coverage and value that are the most important to your overall healthcare experience.

How to choose a health insurance plan that fits your care needs

Knowing how to choose a health plan requires evaluating your individual or family care needs today, while considering any future healthcare needs as well. It's about finding a balance between coverage and affordability, ensuring that you are protected against high out-of-pocket costs while receiving necessary care. When it comes to selecting health insurance, it's essential to consider not just the cost, but also the benefits and coverage the plan offers.

All ACA Marketplace plans provide a range of benefits designed to help support your health and wellbeing, including preventive care including vaccinations and annual check-ups that help catch health issues early, to more significant benefits for emergency care and hospital stays. ACA marketplace health plans also cover mental health services, prescription drug coverage, virtual care visits, and maternity care. 

When evaluating Marketplace health insurance, you’ll want to consider these things:

• Coverage for Yourself or Dependents: Determine whether you need a plan that covers just yourself or one that also includes your family.
  
  
• Frequency of Doctor Visits: Consider how often you and your dependents need care. Preventive care is included with every marketplace plan at no cost for you and your family. But, if regular care from a specialist is necessary, look for plans with lower copays for office visits.
  
  
• Medication Needs: All ACA Health Insurance Marketplace plans include prescription drug coverage. Be sure to check if any current prescription medications you or your family members take are covered under the plans you are considering.
  
  
• Specialized Care Needs: If you require specialized care or treatments, ensure the plan provides enough coverage for those services. This can include mental health benefits, specialized treatments, and physical therapy.

How to compare health insurance plans based on your budget

When choosing a health plan, it’s important to consider your budget. This includes how much you want to pay for your monthly premium, and how much you could expect to pay out-of-pocket for care, including your deductible, copays, and coinsurance. You’ll also want to explore if you qualify for financial help through a premium tax credit or other cost-sharing reductions that could help lower your out-of-pocket costs.

ACA-compliant health insurance plans are categorized into different “metal” levels: Bronze, Silver, Gold, and Platinum. While each level offers the same benefits, the categories reflect how the costs for care are shared between you and your insurer.

Bronze, Silver, and Gold health insurance plans are available through Wellpoint.

The ACA offers health insurance discounts based on your family’s income and size, which can help cut down the cost of coverage. These discounts are available as premium tax credits and cost-sharing reductions (CSRs). Premium tax credits can be applied to lower or eliminate your monthly premium for any metal level health plan. In addition, CSRs are only available when you choose a Silver plan. If you qualify, CSRs help lower your costs for care, including your deductible, copays, coinsurance, and out-of-pocket maximum.

By considering these factors, you're investing in your and your family's health and future, making an informed decision that balances cost with the need for coverage.