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7 expert tips to guide you when shopping for an Obamacare plan

shopping for obamacare plan It's open enrollment time once again for the Affordable Care Act (ACA), also known as Obamacare. Millions of Americans will shop for health insurance coverage through online exchanges between now and Feb. 15, 2015.

But while many of last year's technological kinks have been smoothed out, the process can still get a little complicated.

Mark Fendrick, director of the Center for Value-Based Insurance Design at the University of Michigan, advises consumers to do some research before buying. "Savvy consumers will do their homework before making a decision," he says.

Here are seven tips for choosing the plan that's best for you and your family.

1. Consider the deductible vs. the premium.

To help consumers more easily shop for a health insurance plan, the marketplaces established by Obamacare were broken down into four separate tiers -- bronze, silver, gold and platinum --and your out-of-pocket medical expenses will depend on which tier you choose.

"These four tiers correspond to their level of generosity," says Dr. Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health.

The trade-off, Sommers says, comes by way of monthly premiums versus your deductible, which is the amount of out-of-pocket money you need to spend before insurance kicks in.

"A platinum plan will cover 90 percent of your medical expenses, which means you pay just 10 percent out of pocket. Meanwhile, a bronze plan will cover 60 percent, which means you pay 40 percent out of pocket."

According to Gerald Kominski, director of the UCLA Center for Health Policy Research, think carefully about your future medical needs and how much health care you may use throughout the year in order to make the right decision.

"If you're young and healthy and don't think you'll need regular health care in the coming year, you'll probably be fine with a bronze-level plan," Kominski says. "But if you're older, have a chronic illness or take regular prescription medications, gold or platinum may be a better deal."

2. Consider the details of plans within each tier.

Once you settle on a tier, you may have only a couple of plan choices, or a dozen, depending on where you live and how many insurers are participating in the marketplace, Sommers says.

All new health insurance policies, regardless of what tier, offer the same essential health benefits in 10 categories.

However, Sommers says you should carefully evaluate the details of every health insurance plan offered within a given category, including differences in monthly premiums, deductibles and copayments. Consumers can make these comparisons directly on

"Even within a metal tier, you'll have some variation in things like cost sharing. Some might have a higher deductible while others might have more generous prescription drug coverage," Sommers says.

3. Make sure your health care provider is ‘in-network.’

Affordability means very little if you can't see the doctor or specialist you'd like, says Chris Holt, director of health care policy for the American Action Forum, a Washington, D.C.-based public policy think tank.

In 2014, many Americans bought marketplace plans only to realize they couldn't access the health care provider they wanted because he or she wasn't in-network, Holt says.

Holt says consumers should not only visit the insurer's website to find out which health care providers are in-network, but actually call the insurer and ask about specific doctors and specialists.

Also, call your health care provider and ask if they are in-network under the insurance plan you’re considering.

4. Consider a catastrophic plan.

If you're under 30 years old (or suffer from extreme financial hardship) and catastrophic health insurance may be the way to go.

These plans, which are also offered through ACA exchanges, come with very high deductibles (up to several thousand dollars, according to but very low monthly premiums -- maybe as low as $35 a month.

However, they’re only meant to protect individuals against worst-case scenarios such as an athletic injury or an accident that requires surgery.

Catastrophic plans also cover three primary care visits per year at no cost as well as 15 free preventative services each year, including blood pressure, cholesterol, HIV, Type 2 Diabetes and depression screenings.

5. Find out if your state has expanded Medicaid.

As of December 2014, 28 states and Washington, D.C., expanded eligibility requirements for Medicaid.

That means uninsured residents in these states may now gain access to this need-based, federally subsidized health insurance if they’re younger than 65, with an annual income of up to 133 percent of the federal poverty level (or less than $16,105 for one person).

According to Families USA, a Washington, D.C.-based nonprofit group that advocates for lower health care costs, the expansion of Medicaid has provided health insurance to millions of low-income families and individuals who would not otherwise be able to afford insurance.

For instance, more than 2.1 million California residents may now gain access to Medicaid since the state expanded its coverage.

6. Consider available tax credits.

According to Cheryl Fish-Parcham, private insurance program director at Families USA, people who earn up to 400 percent of the federal poverty level may qualify for financial assistance in the form of tax credits.

Use our Obamacare subsidy calculator to see if you qualify for a tax break. 

So if you’re an individual earning less than $46,680 a year, or a family of four bringing in less than $95,400 a year, you should qualify. And the less you earn, the larger the credit will be.

The bottom-line premium is going to vary wildly depending on income and geography, but according to Fish-Parcham, about 85 percent of all individuals buying private insurance receive financial assistance with an average annual subsidy of $2,752.

7. Even if you bought last year, explore your options.

Even though it may seem like the easier option to just renew your current plan, Sommers suggests shopping around.

"First of all, you might be eligible for different tax credits this year. What's more, there are a lot of new plans offered this year that weren't offered last year," Sommers says.

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