The vast majority of Americans will find multiple options for health insurance coverage for 2023 on HealthCare.gov after open enrollment began Tuesday under the Affordable Care Act.
Experts say people searching for plans on the government marketplace should consider their budget, health and doctors before picking a plan.
More than 14.5 million people get health insurance through the ACA, commonly known as Obamacare. The number swelled during the coronavirus pandemic after Congress passed generous subsidies to make coverage more affordable.
Most people have three or more options, but about 8% of participants will have only two insurance carriers to choose from.
According to the Biden administration, 80% of consumers should be able to find a plan for $10 or less a month after tax credits.
Here’s what you need to know to navigate the Affordable Care Act marketplace:
HOW DOES THE ACA MARKETPLACE WORK?
The ACA marketplace is geared toward people who don’t have health insurance through their jobs, Medicare, Medicaid, the Children’s Health Insurance Program or another source.
Premium tax credits and other savings reducing the cost of insurance are based on income and the number of people in your family. For example, people with a yearly income between $13,590 and $54,360 are eligible for a subsidy. Those who make less than that qualify for Medicaid.
You can use the HealthCare.gov calculator to determine the savings available to you.
WHAT ARE THE DEADLINES?
The deadlines for coverage in 2023 are: Dec. 15 for coverage that starts Jan. 1 and Jan. 15 for coverage that begins Feb. 1.
WHAT TO LOOK FOR IN PICKING A PLAN
Shop around even if you’re currently covered under the ACA.
First, you’ll want to see what the monthly premium — the amount you pay for coverage — will be.
Next, check the plan’s deductible — that’s what you pay up front for health services before your insurance begins to share some of the remaining costs for the year.
Look into the plan’s copayments or coinsurance — the the fees you pay every time you visit the doctor’s office or go to an urgent-care clinic, for example. Plans with coinsurance can be trickier to budget for because you pay a percentage of the service cost, not a set fee.
Make sure to know the out-of-pocket maximum. After you hit that number, your insurance will cover 100% of costs. Keep that number in mind if you might have big health expenses — major surgery, childbirth or ongoing therapy or treatment — in the next year.
“If you know you’re going to be hitting that out-of-pocket max no matter what, maybe you look at the lower premiums and higher deductible plan,” said Kelly Rector, an insurance broker and president of Missouri-based Denny and Associates.
DOES YOUR DOCTOR PARTICIPATE IN A PLAN?
Do you want to continue seeing a favorite doctor or need a prescription drug covered on your plan?
HealthCare.gov also offers search features and tools to check whether your doctor or prescription drugs are covered under specific plans.
Those are “the biggest things” Rector recommends consumers check when searching the marketplace.
WHAT LEVEL PLAN TO CHOOSE?
All plans cover basic health services, including preventive care, prescription drugs, mental health services and pregnancy.
There are four levels of plans offered: bronze, silver, gold and platinum. Bronze plans have the lowest premiums but the highest out-of-pocket costs. Premium costs increase as you go up the medal ladder, but deductibles are lower.
The best deal for people who qualify for extra savings is a silver plan, said Cynthia Cox, the Kaiser Family Foundation’s director for the Affordable Care Act program.
“If you’re just barely making above the poverty level, you really should be buying a silver plan, with the lowest premiums, lowest deductibles,” Cox said.
In some cases, those plans will still be nearly free and will have much lower copays and deductibles, making for the best deal in the long run. Depending on your income, you might have to pay a monthly premium of $15 to $20, but the lower costs to the overall plan still make a better deal, Cox said.
For people in higher income brackets, your subsidies won’t be as big — if you qualify at all — and the plans will be pricier.
If you’re young and healthy and don’t anticipate significant health care needs, the bronze plan remains a reasonable choice, according to Rector. High-deductible “catastrophic plans” are also available to people under 30.
IF YOU HAVE QUESTIONS, NEED FREE HELP
“Navigators” supported through government funding can provide free consultations to help you choose a health insurance plan and help with your application. You can find one near where you live to speak with in person, by phone or via email by searching https://localhelp.healthcare.gov/. Agents and brokers also are available to help. They charge fees but typically provide their services for free to consumers and charge the insurance companies instead.
