Compare health insurance prices in the Healthcare marketplace.
Health Insurance Payments: Premiums, Deductibles and out-of-pocket costs
- Premium: The bill you pay to your insurance company every month. All search results are organized from lowest to highest premium payments.
- Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)
- Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible
- Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
Health Insurance Plan Categories
Categories are based on how you and your health insurance plan split the costs of your health care.
|Plan Category||The insurance company pays||You pay|
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.
- Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
- Moderate monthly premium
- Moderate costs when you need care
- Silver deductibles are usually lower than those of Bronze plans.
- Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
- High monthly premium
- Low costs when you need care
- Deductibles are usually low.
- Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.
- Highest monthly premium
- Lowest costs when you get care
- Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
- Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.
Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible.
- Only people under 30 are eligible or
- People of any age with a hardship exemption or affordability exemption
- Monthly premiums are usually low, but you can’t use a premium tax credit to reduce your cost.
- Deductibles are very high. For 2017, the deductible for all Catastrophic plans is $7,150. After you spend that much, your insurance company pays for all covered services, with no copayment or coinsurance.
What Catastrophic plans cover
- Catastrophic plans cover the same essential health benefits as other Marketplace plans.
- Like other plans, Catastrophic plans cover certain preventive services at no cost.
- They also cover at least 3 primary care visits per year before you’ve met your deductible.
Types of Marketplace plans
Some examples of plan types you’ll find in the Marketplace:
- Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
- Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
- Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
- Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.