How to get health insurance

How to Get Health Insurance

Choose among these five different options

If you need to buy health insurance, you’re in good company. In 2020, the number of uninsured people in the United States increased (for the fourth year in a row) to approximately 30 million individuals. We’ll explain each option for buying your own health insurance so you can decide which path might be best for you.

Key Takeaways

Option 1: Use the Government’s Health Insurance Marketplace

The Health Insurance Marketplace is often referred to as the health insurance “exchange.” Depending on your income and your eligibility for other health insurance coverage, you may qualify for subsidies—also called premium tax credits—when you buy health insurance through the marketplace.

You can buy a marketplace policy even if you are eligible for insurance through your employer, and it doesn’t hurt to see if you can find a better plan for your situation. You probably won’t be eligible for subsidies if you have access to job-based coverage, though.

Open enrollment for 2022 coverage began Nov. 1, 2021. You had to enroll by Dec. 15 for coverage that began Jan. 1, 2022. In 2021, amid the ongoing COVID-19 pandemic, the open enrollment period was extended from Feb. 15 to May 15.

State exchanges may have slightly different enrollment dates. It’s important to buy a policy during this annual enrollment period because you won’t be able to buy a policy for the rest of the year unless you have a qualifying life event like moving, getting married, or having a child.

You can apply online, by phone, or in person. If you need help applying, you can work with a marketplace navigator in some states, a certified application counselor, or in-person assistance personnel. You must be a U.S. citizen or lawfully present in the country to buy a marketplace plan.

Start your search for a marketplace policy at HealthCare.gov. Enter your zip code and you’ll be directed to buy a policy through the federal marketplace. If your state has its own marketplace, you’ll be redirected to your state’s website. You can also find direct links to state exchanges at Healthcare.gov’s The Marketplace in your state site.

If you aren’t sure whether you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can find out by visiting your state’s Medicaid website or by filling out an application at HealthCare.gov.

In 2021 and 2022, all taxpayers with insurance bought on the Marketplace are eligible for the Affordable Care Act (ACA) premium tax credit; previously, filers were ineligible if their income exceeded 400% of the federal poverty line.

Option 2: Work With an Agent or Broker

An agent or broker can help you find a good policy for you because they have experience evaluating health insurance plans. The federal government’s Find Local Help tool can help you locate a marketplace-trained private insurance broker. To learn about the greatest number of options and get the least-biased advice, you may want to work with a broker that sells both marketplace and non-marketplace plans.

Health insurance companies pay brokers when they sell policies. Consumers don’t pay a fee to brokers, nor do they pay higher premiums to work with them. “Agent” usually means someone who only sells policies from one insurance company, while “broker” means someone who sells policies from multiple insurance companies.

Private insurance brokers may also show you options on private enrollment sites from insurance companies and web brokers. If you want to qualify for subsidies, however, you should apply through Healthcare.gov or your state exchange.

The government’s health insurance navigators will only show you marketplace plans available through Healthcare.gov. All of these plans are eligible for subsidies, and a navigator’s help is free.

Option 3: Buy Directly From an Insurer

The Health Insurance Marketplace does not include every health insurance plan available. Some people might be able to find a plan that better meets their coverage needs or their budget outside the marketplace. When you’re shopping for a policy on a single insurer’s website, you will, of course, only see options available from one insurer. You’ll need to visit several insurers’ websites to see all your options if you want to buy direct.

Affordable Care Act (ACA)-compliant plans sold outside federal and state exchanges must meet the minimum essential coverage standards of the ACA, such as covering pre-existing conditions, providing essential benefits, and offering preventive care at no cost before you meet your deductible.

You can also buy non-ACA-compliant short-term plans (up to 12 months) outside the exchanges that may have more exclusions and fewer benefits. People who are between insurance carriers might think that having some insurance is better than having none at all. Short-term health insurance plans market their perceived coverage as an excellent alternative to ACA-compliant insurance that comes with lower premium costs.

But those lower costs do not mean equal coverage for the consumer. Most short-term plans deny coverage to patients with pre-existing conditions and sharply limit mandated ACA vital essential health benefits (prescription drugs, mental health services, prescription drugs, and maternal care), leaving many with the costly remaining balance. These strategic policy limitations on applicants and the coverage plan are the real reasons behind this alleged affordability. Proceed with caution concerning short-term health insurance because the financial risk may outweigh the financial gains in cost savings.

In short, pay close attention to what you’re signing up for if you apply through a private exchange and when considering any so-called alternative to traditional health plans. If you don’t apply through the federal marketplace, keep in mind that you won’t be eligible for subsidies. If your state operates its own health insurance marketplace, you should buy your health insurance plan through your state marketplace to make sure your plan is eligible for subsidies.

If your income is too high to qualify for subsidies, you might not care. But if you end up earning less than expected in the coming year, you could end up unexpectedly qualifying for subsidies, so you might want to keep your options open. Subsidies are based on how much you earn in the year for which you’re buying coverage. When you enroll, you’ll only be getting an estimate of your subsidies based on your estimated income.

Option 4: Buy Through an Online Health Insurance Brokerage

Online health insurance brokerages—also called private enrollment websites or private exchanges—offer to help you compare health insurance plans or get the best available plan based on the information you give them. Comparison shopping is smart, but consumers should understand that these sites will not show them every plan in the market that meets their requirements.

Instead, these private exchanges will show a selection of plans that will earn them a commission if the consumer enrolls. They may display more prominently or provide more information on the plans that earn the brokerage a higher commission.

These marketing incentives don’t necessarily mean the plans these sites offer aren’t good plans. It just means consumers should be aware that they might not be getting a complete picture of their options when they visit one of these sites.

Private enrollment websites may ask you for personal information that the federal and state marketplaces do not. They may ask about your height, weight, and pre-existing conditions—factors that can affect your eligibility for plans that don’t comply with the Affordable Care Act. The company behind the website may also use the personal information you give it to as well as their business partners to market other products to you.

As with buying a policy directly from a health insurance company, you cannot get premium tax credits (subsidies) if you buy your health insurance policy through a private exchange.

Option 5: Buy Through a Membership Organization

If you belong to a union, alumni association, professional organization, or any other large group, you may be able to purchase health insurance through it at group rates. Freelancers Union, for example, offers health insurance through its subsidiary, Freelancers Insurance Agency, and through one of its partners, HealthPlanServices.

When looking for health insurance through an association or membership organization, make sure you will actually be purchasing insurance and not just a health services discount plan. Discount plans might save you money on prescriptions or eyeglasses, but they won’t help you if you get cancer. Also be aware that even if the association itself is a not-for-profit organization, it may be tied to or even established by a for-profit insurance agency through which it sells policies to association members.

Beware of Healthcare-Sharing Ministries

The misconception that healthcare-sharing ministries are a form of health insurance can put patients in a financial hole. Healthcare-sharing ministries are operated by non-profit organizations made up of people with a common belief who agree to help pay one another’s medical bills. They may be attractive to healthy individuals looking for low-cost coverage, but they do not provide actual health insurance and are not held to the same standards as regular health insurance companies. In fact, they are under no obligation to pay their members’ medical bills. As a result, some procedures and costs may not be paid for through the membership, and other mandatory ACA critical benefits for substance abuse and mental health are not covered.

Healthcare-sharing ministries generally do not cover pre-existing conditions, often charge higher rates based on health status using a process known as underwriting, and do not guarantee reimbursement, even for the conditions they cover. Although the upfront cost to join a healthcare-sharing organization might be lower than the premiums and other costs of an ACA plan, it might amplify financial stress in the long term. A number of states have taken legal action against healthcare-sharing ministries and have stepped up warnings to consumers.

How Much Does Health Insurance Cost?

In 2021, the average premium for single coverage increased by 4%, and the average premium for family coverage increased by 4%. The average family premium has increased 47% since 2011 and 22% since 2016, according to KFF.

How Do I Get Health Insurance if I Am Retired?

If you are retired but still under the age of 65 and no longer have employment health insurance due to job loss, you can apply for coverage through the healthcare Marketplace. Losing coverage will qualify you for a special enrollment period. Based on household size and income, you may qualify for a premium tax credit and lower out-of-pocket costs.

Retirees who are 65 and older will qualify for Medicare and Medicare Advantage. You can also switch to a Marketplace plan if you have retiree health coverage but won’t be eligible for the tax credits and lower out-of-pocket benefits or the special enrollment period. If you turn 65 in the middle of the year, you can apply for a Marketplace plan to cover you until Medicare begins.

If you are 65 but do not qualify for premium-free Medicare, you can buy insurance through the Marketplace and receive lower costs with tax credits.

How Do I Get Health Insurance If I Have a Disability?

If you have a terminal illness, need daily assistance with care at home or in a group setting, live in a long-term care or group home, have a disability, or have a condition that limits your employment, there are options available. Disabilities are covered under pre-existing health conditions, and plans cannot charge you more due to your health circumstances before coverage.

With Social Security Disability Income (SSI), you can apply for coverage through Medicaid. Most states automatically grant Medicaid when you get approved for SSI based on disability, although in some states, SSI does not guarantee Medicaid. It pays to check your state’s rules. In some states, SSI guarantees eligibility, but separate registration is still necessary.

If you have Social Security Disability Insurance (SSDI), you can apply for coverage through Medicare.

Unfortunately, you cannot supplement or change your insurance to a Marketplace plan if you have Medicare already. If you are enrolled in a Marketplace plan prior to your Medicare application, you can keep it as supplement insurance—but you will forfeit any premium tax credits and additional savings offered.

How Do I Get Health Insurance if I Am Self-Employed?

If you own your own business, you can apply for health coverage through the Marketplace. Your income and household size may qualify you for premium tax credits and other insurance savings. There could also be free or low-cost coverage through CHIP or Medicaid programs in your state. Marketplace plans allow business owners to insure their children and spouses. Healthcare savings are based on an estimate of net earnings in the year you apply, not the previous year’s income.

The Bottom Line

If you don’t get health insurance through work or through Medicare, you have several ways to apply for coverage.

If you’re comfortable doing the research and comparing plans on your own, you can apply yourself through Healthcare.gov. Going through the government’s website can also tell you if you’re eligible for Medicaid and/or CHIP.

If you need help finding the right plan or applying, you can work with a marketplace assistance counselor, navigator, or broker. All of these individuals’ services are free.

You don’t have to buy health insurance through the federal exchange or your state’s exchange (or at all), but you won’t be eligible for premium tax credits unless you do.

Finally, make sure to buy a policy during the annual open enrollment window. It’s your best opportunity to buy affordable, comprehensive coverage.

How to Get Free or Low-Cost Health Insurance

Lisa Sullivan, MS, is a nutritionist and health and wellness educator with nearly 20 years of experience in the healthcare industry.

You might be surprised by how expensive the cost of health insurance is in the United States is. However, the cost isn’t the only challenge for people navigating health insurance—it’s also a complex system.

This article will explain what you need to know about obtaining affordable health insurance, even if your income is low.

Where to Get Health Insurance

In the U.S., you can potentially get health insurance through several different sources. Insurance can be provided by the government or by your job or university. You can also buy it from a private health insurance company.

Before you start exploring your options, you should know that health insurance is never really free and is rarely low-cost.

If your health insurance is free or low-cost, it means that either:

Key Terms to Know

There are a few words that will frequently pop up when you’re shopping for health insurance. It’s important that you understand what they mean. This will help you make an informed choice about coverage.

Here is an overview of several options for free or low-cost health insurance. You’ll learn who is eligible, how to apply, and what to expect from each option.

Medicaid

Medicaid is a social welfare program. It provides government-based health insurance to low-income people. The insurance covers a lot of services, which means that it’s comprehensive.

In most cases, Medicaid is free health insurance for people who qualify. A few states charge small premiums for people on the higher end of the Medicaid-eligible income scale.

In addition to no premiums, there is no or minimal cost-sharing (for example, deductibles or copayments).

Who Qualifies?

Medicaid works slightly differently in each state. To be eligible, you must meet low-income guidelines.

These guidelines vary depending on several factors including your age, whether you’re pregnant, and whether you’re disabled.

As a result of the Affordable Care Act’s expansion of Medicaid, here is an overview of who is covered in most states:

As of 2022, there are 11 states where being low-income by itself will not make you eligible for Medicaid.

Can Immigrants Qualify?

Medicaid is sometimes available to immigrants who have been legally residing in the U.S. for five years or more if they meet the eligibility requirements. Medicaid is not usually available to undocumented immigrants, but there can be exceptions.

One example is short-term limited Medicaid coverage in an emergency or emergency coverage for people who are pregnant.

Again, Medicaid eligibility varies from state to state. For example, California has chosen to extend Medicaid eligibility to undocumented children and young adults who otherwise meet the income criteria for eligibility.

Who Pays for Medicaid?

Medicaid is paid for by federal and state taxes. It is administered at the state level. That’s why coverage and eligibility rules vary from one state to another.

If you receive Medicaid, your friends, neighbors, and fellow citizens are paying for your health care with their tax dollars.

If you get Medicaid, you’ll likely be cared for at the same hospitals and by the same physicians as people who have private health insurance.

Even though Medicaid is government health insurance, most of the care provided to people who receive it comes from private businesses and healthcare providers. Most states contract with private insurance companies to administer coverage. On your ID card, you might the name and logo of a well-known insurance provider.

You can apply for Medicaid through your state’s ACA health insurance exchange or by contacting your state’s Medicaid program directly.

Recap

Medicaid is free or low-cost insurance that is paid for federal and state taxes. You can get it if you have a low income and meet other eligibility requirements. That said, states have different rules about Medicaid.

Health coverage options if you’re unemployed

If you’re unemployed you may be able to get an affordable health insurance plan through the Marketplace, with savings based on your income and household size. You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Your household size and income, not your employment status, determine what health coverage you’re eligible for and how much help you’ll get paying for coverage.

If you have just left your job for any reason and lost your job-based health coverage, you qualify for a Special Enrollment Period. This means you can enroll in a Marketplace insurance plan any time of year. You usually have 60 days from the day you lose your coverage to enroll. Learn how to apply for a Special Enrollment Period.

There is no limited enrollment period for Medicaid or CHIP. If you qualify, you can enroll in these programs any time of year. You’ll find out if you qualify when you fill out your Marketplace application.

Your options depend on your household income

When you apply for Marketplace coverage you’ll estimate your income for the current calendar year.

It’s hard to predict your annual income if you’re unemployed. Still, it’s important to make your best estimate based on all current or expected sources of income for the year.

Types of income to include on your application:

Note: It’s very important to immediately update your income information with the Marketplace if your income changes during the year. This will ensure you get the right amount of savings based on your new annual income estimate.

Medicaid, CHIP, and insurance plans through the Marketplace

When you fill out a Marketplace application, you’ll find out if you qualify for any of these types of coverage:

After you finish your Marketplace application, you’ll get an eligibility determination that tells you what kind of coverage you and others in your household qualify for.

More answers

Yes. You’ll need to report your expected unemployment compensation when applying for health coverage through the Marketplace.

When you complete a Marketplace application, you’ll need to predict your income for the coverage year the best you can. The application will help you make this estimate. Learn about how to estimate your income.

It depends on the kind of account you’re withdrawing from. Generally, the amount of your income from a retirement account distribution depends on the type of retirement account, how much you contributed to it, and whether you were already taxed on the amount you contributed.

Withdrawals from a traditional IRA or SEP-IRA generally count as income. (If you made only tax-deductible contributions, all of it is considered income. If you made non-deductible contributions, see IRS Form 8606 (PDF). Roth IRAs are different. Qualified withdrawals from a Roth IRA are not considered income. For more information, see IRS Publication 590. Withdrawals from a 401k plan are generally counted as income (your pre-tax contributions, an employer’s matching contributions, as well as earnings, are included in income). But qualified distributions from a designated Roth account in a 401(k) plan are not considered income. For more information, see IRS Publication 575.

Like other Americans, you must have qualifying health coverage or pay a fee for plan years 2018 and earlier. This is true regardless of your employment status.

There are several exemptions from the fee that may apply to people who have no income or very low incomes. See the full list of exemptions for 2018. If you have an exemption, you don’t need to pay the fee for being uncovered when you file 2018 taxes in the spring. Note: Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the fee no longer applies. You won’t need an exemption for 2019 and beyond.

If you’re eligible for coverage under a family member’s job-based plan, even if you don’t enroll in it, you may not be able to get lower costs on Marketplace coverage based on your income. This will depend on whether the job-based insurance that’s offered to you is considered affordable and meets certain minimum value standards.

You can learn whether the plan is considered affordable and meets minimum standards by asking the employer to fill out an Employer Coverage Tool (PDF). Use information from this completed form to fill out your application. If your family member’s job-based coverage isn’t offered to spouses or dependents, you can qualify for lower costs on a Marketplace plan. If this is the case, only the person with the job-based coverage won’t qualify for lower costs. Note: Having access to job-based coverage doesn’t affect your eligibility for Medicaid.

When your situation changes, update your Marketplace information immediately. Learn how to report household and income changes to the Marketplace.

Losing job-based coverage qualifies you for a Special Enrollment Period. This means you’ll be able to apply for coverage through the Marketplace outside the Open Enrollment Period.

If you’re eligible for your spouse’s job-based coverage, you may not be able to get lower costs on a Marketplace plan based on your income. This will depend on whether the job-based plan is considered affordable and meets certain minimum value standards. If you enroll in the job-based plan, you can’t get any savings on Marketplace insurance.

The health care law has expanded funding of community health centers, which provide primary care to millions of Americans on a sliding scale based on income. Learn about community health centers.

If you or someone in your household got unemployment income for at least one week in 2021, your whole household may have been eligible for more savings and lower costs on a Marketplace plan. Because this one-time extra savings is no longer available for 2022 Marketplace coverage, you may get less financial help.

How to Choose Health Insurance: Your Step-by-Step Guide

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You typically have a limited amount of time to choose the best health insurance plan for your family, but rushing and picking the wrong coverage can be costly. Here’s a start-to-finish guide to help you find affordable health insurance, whether it’s through a state or federal marketplace or through an employer.

Step 1: Choose your health insurance marketplace

How you shop for health insurance will depend on what’s available to you.

If your employer offers health insurance

Most people with health insurance get it through an employer. If your employer offers health insurance, you won’t need to use the government insurance exchanges or marketplaces, unless you want to look for an alternative plan. But plans in the marketplace are likely to cost more than plans offered by employers. This is because most employers pay a portion of workers’ insurance premiums.

If your employer doesn’t offer health insurance

Shop your state’s online marketplace, if available, or the federal marketplace to find the plan that’s best for you. Start by going to HealthCare.gov and entering your ZIP code. You’ll be sent to your state’s exchange, if there is one. Otherwise, you’ll use the federal marketplace.

You can also purchase health insurance through a private exchange or directly from an insurer. If you choose these options, you won’t be eligible for premium tax credits, which are income-based discounts on your monthly premiums.

Step 2: Compare types of health insurance plans

You’ll encounter some alphabet soup while shopping for the best health insurance plan. The most common types of health insurance policies are HMOs, PPOs, EPOs and POS plans. What you choose will help determine your out-of-pocket costs and which doctors you can see.

Comparing health insurance plans: HMO vs. PPO vs. EPO vs. POS

Do you have to stay in-network to get coverage?

Do procedures & specialists require a referral?

HMO: health maintenance organization

Yes, except for emergencies.

Lower out-of-pocket costs and a primary doctor who coordinates your care for you, but less freedom to choose providers.

PPO: preferred provider organization

No, but in-network care is less expensive.

More provider options and no required referrals, but higher out-of-pocket costs.

EPO: exclusive provider organization

Yes, except for emergencies.

Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers.

POS: point of service plan

No, but in-network care is less expensive.

More provider options and a primary doctor who coordinates your care for you, with referrals required.

HMO: health maintenance organization

Lower out-of-pocket costs and a primary doctor who coordinates your care for you, with referrals required to see a specialist. You must stay in-network except for emergencies.

PPO: preferred provider organization

More provider options and no required referrals, but higher out-of-pocket costs. You can go out of network, but care will be more expensive.

EPO: exclusive provider organization

Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers. You must stay in-network except for emergencies.

POS: point of service plan

More provider options and a primary doctor who coordinates your care for you, with referrals required to see a specialist. You can go out-of-network, but care will be more expensive.

Look for a summary of benefits

Online marketplaces usually provide a link to the summary of benefits, which explains all the plan’s costs and coverages. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

Weigh your family’s medical needs

Look at the amount and type of treatment you’ve received in the past. Though it’s impossible to predict every medical expense, being aware of trends can help you make an informed decision.

Consider whether you want a referral system of care

Plans that require referrals

If you choose an HMO or POS plan, which require referrals, you typically must see a primary care physician before scheduling a procedure or visiting a specialist. Because of this requirement, many people prefer other plans. However, by limiting your choices to providers they’ve contracted with, HMOs do tend to be the cheapest type of health plan.

A benefit of HMO and POS plans is that there’s one primary doctor managing your overall medical care, which can result in greater familiarity with your needs and continuity of medical records. If you do choose a POS plan and go out-of-network, make sure to get the referral from your doctor ahead of time to reduce out-of-pocket costs. (You cannot go out-of-network with an HMO unless it’s an emergency.)

Plans that don’t require referrals

If you would rather see specialists without a referral, you might be happier with an EPO or a PPO. (EPOs typically don’t require a referral, but some do, so read the fine print.) An EPO may help keep costs low as long as you find providers in-network; this is more likely to be the case in a larger metro area. A PPO might be better if you live in a remote or rural area with limited access to doctors and care, as you may be forced to go out-of-network.

What about an HDHP with a health savings account?

Step 3: Compare health plan networks

Your health insurance “network” refers to the medical providers and facilities your health plan has contracted with to provide your care.

Why does the network matter?

Costs are lower when you go to an in-network doctor because insurance companies negotiate lower rates with in-network providers. When you go out-of-network, those doctors don’t have agreed-upon rates, and you’re typically on the hook for a higher portion of the cost.

Do you have preferred doctors?

If you want to keep seeing your current medical providers, make sure they’re in the provider directories for the plan you’re considering. You can also ask your doctors directly if they take a particular health plan.

Is a large network important?

If you don’t have a preferred doctor, it’s probably a good idea to look for a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community, since it’ll give you better odds of finding a local doctor who takes your plan.

Eliminate any plans that don’t have local in-network doctors, if possible; you may also want to eliminate those that have very few provider options compared with other plans.

Step 4: Compare out-of-pocket costs

Out-of-pocket costs (that is, costs other than your monthly premium) are another key consideration. A plan’s summary of benefits should clearly lay out how much you’ll have to pay out of pocket for services. The federal online marketplace offers snapshots of these costs for comparison, as do many state marketplaces.

Know your health insurance terms

It’s useful to know the definitions of some key health insurance terms:

Coinsurance: This is the percentage (such as 20%) of a medical charge that you pay; the rest is covered by your health insurance plan.

Deductible: This is the amount you pay for covered medical care before your insurance starts paying.

Out-of-pocket maximum: This is the most you’ll pay in one year, out of your own pocket, for covered health care. Once you reach this maximum, your insurance pays the rest.

Out-of-pocket costs: These are all costs above a plan’s premium that you must pay, including copays, coinsurance and deductibles.

Premium: This is the monthly amount you pay for your health insurance plan.

Higher premiums, more coverage

In general, the higher your premium, the lower your out-of-pocket costs such as copays and coinsurance (and vice versa). A plan that pays a higher portion of your medical costs, but has higher monthly premiums, may be better if:

You see a primary physician or a specialist frequently.

You frequently need emergency care.

You take expensive or brand-name medications on a regular basis.

You’re expecting a baby, plan to have a baby or have small children.

You have a planned surgery coming up.

You’ve been diagnosed with a chronic condition such as diabetes or cancer.

Lower premiums, higher out-of-pocket

A plan with higher out-of-pocket costs and lower monthly premiums might be the better choice if:

You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.

You’re in good health and rarely see a doctor.

Step 5: Compare benefits

By this step, you’ll likely have your options narrowed down to just a few plans. Here are some things to consider next:

Check the scope of services

Go back to that summary of benefits to see if any of the plans cover a wider scope of services. Some may have better coverage for things like physical therapy, fertility treatments or mental health care, while others might have better emergency coverage.

If you skip this quick but important step, you could miss out on a plan that’s much better suited to you and your family.

Address any lingering questions

In some cases, calling the plans’ customer service line may be the best way to get your questions answered. Write your questions down ahead of time, and have a pen or electronic device handy to record the answers.

Here are some examples of what you could ask:

I take a specific medication. How is that medication covered under this plan?

Which drugs for my condition are covered under this plan?

What maternity services are covered?

What happens if I get sick while traveling abroad?

How do I get started signing up, and what documents will I need?

Don’t forget to discontinue your old plan, if you have one, before the new one starts.

Summary: How to choose health insurance

Here’s a quick recap:

Go to your online health insurance marketplace and view all of your plan options.

Decide which type of health insurance plan — HMO, PPO, EPO or POS — is best for you and your family, and whether you want an HSA-eligible plan.

Eliminate plans that exclude your preferred doctor or that don’t have local doctors in the provider network.

Determine whether you want more health coverage and higher premiums, or lower premiums and higher-out-of-pocket costs.

Make sure any plan you choose will pay for your regular and necessary care, like prescriptions and specialists.

About the authors: Lacie Glover is an insurance editor and writer and a NerdWallet authority on insurance. Her work has been featured by USA Today, U.S. News and World Report and The Associated Press. Read more

Kate Ashford is a certified senior advisor (CSA)® and personal finance writer at NerdWallet specializing in Medicare and retirement topics. Read more

3 things to know before you pick a health insurance plan

START HERE

How to Choose a Plan in the Health Insurance MarketplaceВ®

Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.

The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.

Your total costs for health care: You pay a monthly bill to your insurance company (a «premium»), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.

Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.

Remember that plans also may differ in quality. Learn more about quality ratings.

Want to compare plans & prices now?

Provide some income and household information to see plans available in your area, with estimated prices based on your income.

More Answers: What to know before you pick a health insurance plan

You can search, compare, and assess providers, hospitals, and other care facilities using these tools.

Use this quick tool to see if your income estimate falls in the range for a premium tax credit and cost-sharing reductions. The type of savings you qualify for may affect which plan category is the best fit for you.

You can view a summary of benefits, a plan brochure, a provider directory, and a list of covered drugs for each plan. You’ll find links to all of these when you’re comparing Marketplace plans or previewing plans and prices before you log in.

You can also search for your doctors, medical facilities, and prescription drugs when you compare plans. Select your doctors, hospitals and other medical facilities, and prescription drugs. When you view plans, we’ll tell you if each one covers them in network.