How to shop for a health plan on the ACA Marketplace
First things first, the Affordable Care Act (ACA) annual open enrollment period for this year is November 1, 2023, to January 15, 2024. If you miss this window, you may have to wait until the next open enrollment period unless you qualify for a Special Enrollment Period (SEP).
Shopping on the ACA Marketplace is surprisingly easy and can be done in a few steps. Here’s a step-by-step guide on how to get started:
- Visit the Healthcare.gov Website: The official website for the ACA Marketplace is Healthcare.gov. Go to this website to start the enrollment process.
- Create an Account: If you’re a new applicant, you’ll need to create an account. If you’re returning to the Marketplace, you can log in with your existing account. If not, you’ll need to provide information like names, birthdates, Social Security numbers, immigration status, household income information (this helps determine whether you may be eligible for tax credits and cost-sharing subsidies.)
- Browse and Compare Plans: Once enrolled, you can browse all the available health insurance plans. You’ll see a list of different plans with details such as coverage, premiums, deductibles, and out-of-pocket costs. You can even filter and sort plans based on your preferences, such as the level of coverage, monthly premium costs, or the insurance provider.
- Choose a Plan and Complete Application: Once you’ve reviewed your options and decided on a plan, select it and fill out the necessary application forms. You will need accurate information about your household and income. That way, if you qualify for subsidies, this information will be used to calculate your financial assistance.
- Review, Confirm and Submit: Carefully review your application and selected plan before confirming. Make sure all the information is accurate. After confirming your choices, submit your application. You’ll receive a confirmation of your enrollment.
More about ACA health plans and costs
Once you start exploring the plan options, you will quickly discover that there is a wide range of costs. Your premium, or your monthly payment, will vary depending upon where you live, your income, your household size, and what plan you choose.
Generally, ACA plans are organized into four “metal tiers,” which determine how you and your plan split the cost of care.
- Bronze has the lowest monthly premium but also the highest costs when you need care
- Silver is known as the “benchmark” plan, with moderate monthly premiums and moderate costs when you need care. You must choose a silver plan to qualify for cost-sharing reductions. These are also known as extra savings on out-of-pocket expenses such as deductibles, copayments, and coinsurance.
- Gold has high monthly premiums but low costs when you need care
- Platinum has the highest monthly premiums and the lowest costs when you need care
Types of ACA plans and networks – Some plan types allow you to use almost any doctor or healthcare facility. Others limit your choices or charge you more if you use providers outside their network.
HMO – (Health Maintenance Organization) A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO and often provide integrated care and focus on prevention and wellness. They typically have lower premiums.
PPO – (Preferred Provider Organization) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
POS – (Point of Service) A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor to see a specialist.
EPO – (Exclusive Provider Organization) A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
More shopping tips
As you are looking at all the options and trying to decide, always check provider networks on the plans before you buy. If you have preferred doctors or hospitals, make sure they are in-network with the plans you’re considering. This can affect your choice.
Also, remember to keep track of important deadlines, provide accurate information, and update your application if your circumstances change.
If you need assistance or have questions, you can also contact the Marketplace directly or seek help from an ACA navigator or with an agent or broker.
Need more information? Blue KC representatives are ready to help with all your questions about finding a health plan on ACA Marketplace. Give us a call, Monday through Friday, 8:00 a.m. to 6:00 p.m. at 844-655-0355.
