Under the Affordable Care Act (ACA), each state has the option to run its own health insurance marketplace, or to use the federally facilitated one through HealthCare.gov. As of 2025, some states operate fully state-run marketplaces with their own websites, deadlines, and plan offerings—while others rely on the federal government’s platform.

State-Based Marketplaces vs. Federally Facilitated Marketplaces

When the ACA was passed in 2010, it gave states the opportunity to build and manage their own health insurance exchanges. If a state declined, the federal government would step in and provide ACA-compliant plans through HealthCare.gov.

Today:

• 20 states (plus Washington, D.C.) run their own marketplaces

• 3 states use the federal platform for enrollment, but manage their own backend operations

• The remaining 28 states use the federally facilitated marketplace

State-based marketplaces allow local governments more control over how plans are regulated, priced, and promoted. They can also set their own Open Enrollment Period (OEP) dates, which is helpful for residents who need more time to enroll.

States That Operate Their Own Health Insurance Exchanges (2025)

Here are the states that currently operate their own health insurance marketplaces, along with their platform names:

• California – Covered California

• Colorado – Connect for Health Colorado

• Connecticut – Access Health CT

• District of Columbia (D.C.) – DC Health Link

• Idaho – Your Health Idaho

• Maryland – Maryland Health Connection

• Massachusetts – Massachusetts Health Connector

• Minnesota – MNsure

• Nevada – Nevada Health Link

• New Jersey – Get Covered NJ

• New York – NY State of Health

• Pennsylvania – Pennie

• Rhode Island – HealthSource RI

• Vermont – Vermont Health Connect

• Washington – Washington Healthplanfinder

Each of these states may offer unique plan choices, local insurer options, and extended enrollment deadlines beyond the federal window.

When Is Open Enrollment for ACA Plans in 2025?

The federal Open Enrollment Period for 2025 coverage is expected to run from November 1, 2024 through January 15, 2025. However, some state-run marketplaces set their own deadlines and may offer enrollment extensions.

What If You Miss Open Enrollment?

If you don’t enroll during the Open Enrollment Period and don’t qualify for a Special Enrollment Period (SEP), you may have to wait until the next OEP begins in late 2025. Here’s what happens if you don’t take action before the deadline.

Common SEP triggers include:

• Loss of other coverage

• Marriage or divorce

• Birth or adoption of a child

• Moving to a new ZIP code or state

Why Does It Matter Who Runs Your Marketplace?

If your state uses a state-based marketplace, your:

• Enrollment dates may be longer or more flexible

• Health insurance plan options may be broader or include regional carriers

• Application process may take place on a different website (not HealthCare.gov)

Looking for Health Insurance?

The best way to get the right plan for your needs is by working with a licensed health insurance agent. At EZ, our team:

• Works with top-rated insurance companies in every state

• Can help you access premium subsidies and tax credits

• Will walk you through all your health insurance options—federal and state-based

• Does all the heavy lifting for you—at no cost

To get free instant quotes, simply enter your ZIP code in the bar above, or to speak to a local agent, call 855-677-0157.

When it comes to your health insurance, Open Enrollment is the most important time of the year. This is the time that you’ll be able to change your plan, or enroll in a new one that better suits your needs and saves you money. It’s imperative that you know when the Open Enrollment Period (OEP) starts and how long it lasts so that you don’t miss out! If you do miss the OEP, you may have to wait an entire year in order to make changes, that is unless you qualify for a Special Enrollment Period (SEP). With all that being said, it’s super important to act before the deadline and avoid waiting until the last minute. To help you on this endeavor, we’ve outlined the key OEP dates for every state, to ensure you have ample time to get enrolled!

The 2025 OEP begins November 1st, 2024 in most states, and since changes to the OEP last year, it generally runs through January 15th in most states. Some states, though, have extended their OEP a little longer. Take a look at the following so you know when your state’s OEP begins and when it ends.

States With January 15th Deadlines

• Alabama
• Alaska
• Arizona
• Arkansas
• Delaware
• Florida
• Georgia
• Hawaii
• Illinois
• Indiana
• Iowa
• Kansas
• Louisiana
• Michigan
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• South Carolina
• South Dakota
• Tennessee
• Texas 
• Utah
• Virginia
• West Virginia
• Wisconsin
• Wyoming
  

States with Different OEP Dates

Some states with their own ACA exchanges have different date ranges for the 2025 Open Enrollment Period. The chart below shows the State Enrollment Period (SEP) and OEP dates for these states; other states have not yet announced their dates (these are also listed below).

Looking For Affordable Health Insurance?

The health insurance 2025 Open Enrollment Period is open from November 1 until January 15 (depending on your state), so now is the perfect time to reconsider getting a health insurance plan, or looking into your current one and making sure it’s got you covered. And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible. 

If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan meets your financial needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-694-0047. No obligation.

Luckily, you won’t have to feel alone during this OEP, because EZ.Insure is here to help! EZ.Insure makes the enrollment process stress-free and simple. Our easy-to-use platform provides free quotes and side-by-side comparisons of all the available health plans in your area. We also have a team of dedicated agents who are always on hand to help guide you through the process or answer any questions, so you can leave feeling confident in your coverage. To help you feel even more prepared, we’ve compiled a brief list of helpful tips so you can tackle this OEP with ease.

1. Choose an Unbiased Agent

Who you choose to work with when looking for a health insurance plan is a very important decision, and plays a big part in finding a comprehensive, affordable plan. It’s important to work with a licensed, knowledgeable agent who is not connected to a certain type of health insurance plan or insurance company, so you can get an unbiased look at all available options in your area. 

EZ’s agents work with the top-rated health insurance companies in the nation, and we guarantee that we will compare all plans in your area so that you can find the perfect plan. And not only are our agents independent, but they are also always up-to-date on newer healthcare plans, so they can provide you with all the information that you need before you make your decision.

2. Consider ALL of Your Options

After choosing to work with an EZ agent, you can simply ask them to research every option that you have, as well as help you weigh all the pros and cons of each plan. There are many different types of healthcare plans available, including PPO plans, HMO plans, or metal tier plans; if you’re not sure what’s best for you, an EZ agent will go over all of these different plan types, and will not try to limit you to a certain plan. We will lay all of your options on the table and review the coverage and cost of each one.

3. Ask the Right Questions

When it’s time to start searching for plans, think ahead of time about what you want to ask your agent, and what is important to you in a plan. In addition to asking about prices and coverage options, have a list of questions you want to ask, like: 

• Is advanced primary care included in the plan?  
• Can you keep your current doctor? 
• Do you qualify for subsidies for any of the plans? 
• Can you see doctors outside of your network?
• Is mental health care (or anything else you’re interested in having covered) covered?
• Is a higher deductible or lower premium plan better for you?

4. Find the Plan That Has the Most Value

People often choose the cheapest plan available, but this cheapest plan might not have the best benefits available for the price. A good health insurance plan will come from a quality carrier, provide comprehensive benefits, allow you to see the doctors you want to see, and have affordable co-pays. And remember, if you go for the cheapest plan available, you might end up paying more out-of-pocket when you use medical services. Our agent will review your medical needs and budget, and search for a plan that will check all the boxes for you.

Need Help? EZ’s Got You Covered

The health insurance Open Enrollment Period will be open from November 1st through January 15 (depending on your state), so now is the perfect time to reconsider getting a health insurance plan, or to look closely at your current one to make sure it will cover all of the above-mentioned costs. And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible. 

If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan meets your financial needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 855-677-0157. No obligation.

Health insurance is an important component of financial and physical well-being since it allows people to obtain necessary medical care. However, not everyone chooses the health insurance provided by their employment or through government programs. Some people choose to look for alternatives, and one way to do this is to get a health insurance waiver. A health insurance waiver form will typically include information about your request to forgo access to a health insurance plan that has been made available to you. 

Waiving Employer-Sponsored Health Plans

Company-sponsored health insurance plans can be a considerable advantage for employees. Especially when the company pays for all or a portion of the employee’s health insurance benefit. However, it is possible that a person will not require the medical coverage supplied by their work. Employees are not compelled to partake in perks such as health insurance, which is the best part. There is no penalty for refusing coverage.

When an employee does not want their employer’s health insurance, they waive coverage. Employees can also forgo coverage for a family member who was previously covered under their plan. Employees can only opt out of coverage during specific time periods. Here are some examples of when employees can choose to forego coverage:

• When they first start their job and are initially offered coverage.
• During an open enrollment period, which takes place once a year and lets employees enroll, change, or opt out of coverage.
• If the company begins to offer a new plan.
• If someone has a change to their family such as a marriage, divorce, or birth. This qualifies them for a Special Enrollment Period.

The health insurance waiver is frequently considered as an employee perk since some firms offer to reimburse the employee for the financial value of the cost of insurance by waiving insurance. However, because most employers do not cover the entire cost of coverage, there is less of an incentive to avoid providing those benefits.

Keep In Mind

Signing a health insurance waiver may no longer provide any advantage in terms of employee perks in the form of a wage “increase” because many firms no longer pay for their workers’ health insurance benefits as they used to. However, because you will be covered via an alternate plan rather than the employer plan, the waiver may still reduce the costs of payroll deductions for your insurance.

Waiving College or University Health Plans

Universities frequently offer health insurance waivers. Students who are already enrolled in comparable or better health insurance plans than those given by their college or university typically have the option of waiving the health insurance by completing a health insurance waiver form and presenting proof of comparable coverage elsewhere. The submission deadlines for these waivers correlate to school terms. This is a common choice for students because they are frequently covered by a family plan, and the cost savings from foregoing health insurance can amount to thousands of dollars each year.

Proof Requirement

You may also be required to give proof of the reason you seek to forgo health insurance coverage, depending on the organization or reason for your request. This is for the organization, business, or school that is providing you with the plan’s protection.

Before processing your health insurance waiver request, the organization may wish to confirm that you have adequate health insurance elsewhere. Health insurance waivers may need to be signed on an annual basis, and if your circumstances change, you may be required to notify your plan provider.

Why People Use A Health Insurance Waiver

There are numerous reasons why you might decide to forego your health insurance coverage, but before you do, consider the benefits of dual coverage or benefit coordination. If you have a lot of medical bills or specific needs, it may be more beneficial to use multiple plans. Always consider all of your alternatives. For example, you may wish to waive coverage if your employer’s or student’s health insurance plan is not necessary because you already have coverage via another plan. Other circumstances in which you may obtain a health insurance waiver include:

• Spousal Coverage –  Individuals who are qualified for health insurance through their spouse’s employer may choose to forego their own coverage in favor of the spousal plan. This choice may be influenced by factors including cost, coverage options, or personal preferences.
• Government Programs – Individuals may be eligible for government-sponsored health insurance programs, but choose to forego coverage in specific instances. This could be because of a desire for private insurance, unhappiness with the government plan, or specific coverage needs that the public program does not meet.
• Alternative Options –  Some people may have access to other insurance options, such as individual or family plans, and opt out of employer-provided coverage in favor of these options. Cost, coverage scope, and network preferences may all have an impact on the selection.
• Coverage Preferences – Individuals might have specific preferences regarding healthcare providers, networks, or types of coverage. Opting for a waiver allows them the freedom to choose a plan that aligns better with their preferences and needs.

Alternative Health Insurance Options

If you decide to pass on health insurance offered by your job or school and choose to buy individual health insurance it’s important to know your options. There are several types of plans that all cover care in different ways. So it’s easy to find a plan that fits exactly what you need.

Health Maintenance Organizations (HMO)

HMOs offer you the option of choosing from a local network of participating physicians, hospitals, and other healthcare providers and facilities. As part of these health insurance policies, you must choose a primary care physician (PCP) from this network. Your primary care physician (PCP) will get to know you and help you organize all of your medical care. They are also responsible for referring you to any specialists; without this recommendation, your HMO would not cover a specialist visit. Out-of-pocket payments for an HMO plan are frequently lower than those for other types of health plans as long as you stay in-network.

Preferred Provider Organization (PPO)

PPOs offer very vast networks of participating providers. So, you can choose from a wide range of hospitals, clinics, and other healthcare facilities and experts. Unlike HMOs, PPOs provide some coverage for providers outside of their network,. But not as much as they would for an in-network provider. Another significant distinction between PPOs and HMOs is that you are not compelled to select a PCP and can see a specialist without a referral.

Exclusive Provider Organization (EPO)

EPOs also provide you with access to a network of participating providers from which you can choose. The majority of EPO plans, with the exception of emergencies, do not cover care received outside of their network. As a result, if you visit a provider or facility that is not part of the plan’s local network, you will most likely be responsible for the full cost of services. You may or may not be needed to select a PCP depending on the plan. In either case, you will not need a recommendation from a PCP to see a specialist. As long as they are in the network of the plan.

Point of Service (POS)

PPOs and HMOs are combined in POS plans. A POS plan’s provider network, like that of an HMO, is often smaller than that of a PPO plan. And in-network care expenses are typically lower, as with a PPO. In POS plans, you must choose a primary care provider (PCP) from a network of physicians and other primary care specialists.

If you need to see a specialist, you must acquire a referral from a POS. However, like with PPO, you can choose to see in-network or out-of-network experts. However, if you visit an out-of-network provider, your part of the costs will be higher. And you will be responsible for submitting any claims if you visit a physician who is not in the plan’s network.

Health Reimbursement Arrangement (HRA)

An HRA, or health reimbursement arrangement, is a form of health expenditure account provided and owned by the employer. Because they own the HRA, your employer is the only one who can contribute to it. They can also determine if you can roll over unused cash into the next year. The money in it is used to pay for eligible expenses. Including medical, pharmaceutical, dental, vision care, and as defined by the employer.

The Bottom Line

Health insurance waivers give people the freedom to choose how they want to be covered for medical care based on their own needs and circumstances. Even though they give people some freedom. People who decide to not have coverage should carefully think about the risks and other options. In turn, employers and schools have to deal with the paperwork side of health insurance waivers. Making sure they follow the law and encourage open communication. The use of health insurance waivers is still a moving part of the larger conversation about healthcare access and personal freedom, even as healthcare changes.

There are numerous sorts of health insurance plans to choose from. So it all comes down to you: your requirements, your budget, and your overall health. When looking for the best plan, the greatest thing you can do is compare the features of various plans. As a result, you can obtain the most coverage for the least money. Even if you are normally healthy, health insurance is a vital component of life.  You never know what can happen, and it’s always better to be cautious than sorry. To begin, enter your zip code into the box below or call one of our qualified representatives at 877-670-3557.

Health Savings Accounts (HSAs)

Health Savings Accounts are not typical savings accounts, and they are only available to people with a high-deductible health plan (HDHP). As of 2023 an HDHP is defined as any plan with a minimum deductible of $1,500 for individual coverage or $3,000 for family coverage with an out-of-pocket maximum of $7,500 and $15,000 respectively. An HSA is a triple tax advantaged account that can be used to pay for qualifying medical expenses. It’s known as “triple tax-advantaged” because your contributions to your account are not taxed, the money in the account is never taxed while it’s in the account, even if it earns interest or investment returns.

Additionally, as long as you use your HSA funds for qualified medical expenses, your withdrawals will also never be taxed. However, if you use your HSA funds for anything besides qualified medical expenses you will have a 20% tax penalty. Another great thing about HSAs is that you can actually invest your funds as well, similar to the way you would a 401K. This lets your HSA actually make you money, if you invest properly you could end up with a nice health savings account keeping you from having to pay for little to any of your healthcare.

How HSAs Work

If you open an HSA with your HDHP, you will deposit money into the HSA that you can use to pay for qualified medical expenses that your health plan does not cover. Which are any services that the IRS recognizes as a eligible medical costs these expenses include:

• Acupuncture
• Ambulance services
• Birth control/contraceptive devices
• Blood pressure monitors
• Blood sugar test kits/test strips
• Chiropractic therapy/exams/adjustments
• Contact lenses
• Copayments
• Dental care
• Dermatological services
• Diagnostic services
• Eye exams
• Eye surgery
• Flu shots
• Gynecological care
• Incontinence supplies
• Infertility treatments
• Insulin and diabetic supplies
• Laboratory fees
• Lactation expenses
• Legal sterilization
• Laser eye surgery/ LASIK
• Menstrual care products
• Nasal strips
• Obstetric care
• Over the counter (OTC) treatments containing medicine (i.e., cold treatments, pain relievers, sinus medications, etc.)
• Physical exams
• Pregnancy test kits
• Smoking cessation programs
• Therapy or counseling
• Treatment for alcohol or drug dependency
• Vaccinations
• Vision care
• Wrist supports/elastic straps
• X-ray fees

You can use the HSA funds to pay all your medical bills until you reach your plan’s deductible, and then you can use them to cover your coinsurance or copayments until you reach your annual out-of-pocket maximum. Additionally, unlike other health spending accounts, HSA funds will never expire. Your funds roll over into the new year, every year so you don’t have to rush to spend the money in the account. One thing you should note though, is that HSAs do have a contribution limit, these limits change annually but as of 2023 if you have an individual plan you can only contribute up to $3,850 for the year. For family plans the limit is $7,750.

Flexible Spending Accounts (FSAs)

A Flexible Spending Account, sometimes called a Flexible Spending Arrangement, is a type of savings account that offers you specific tax advantages. You don’t actually set these accounts up, instead they are set up by your employer. FSAs let you contribute a portion of your pay into the account. Your employer can also choose to contribute to the FSA on your behalf, sort of like when your employer matches your 401K except the employer decides exactly how much they contribute. The FSA funds are then used to reimburse you for eligible medical and dental expenses. 

How FSAs Work

An FSA is a voluntary plan that allows employees to contribute up to $3,050 a year (as of 2023) to pay for eligible medical expenses that are not covered by their health insurance plan such as:

• Health insurance copayments
• Doctor’s visits
• Coinsurance payments
• Dental work
• Vision expenses
• Prescriptions
• Therapy and counseling services
• Chiropractic care
• Acupuncture
• Hospital fees
• Surgery costs
• Diagnostic services
• Allergy testing

If your employer offers group health insurance they can also offer these FSA plans as an additional employment benefit. Your employer can choose to also contribute to your FSA, they can choose to match your contributions or decide to pay a smaller amount. They are not required to contribute though, so some employers might not add into your FSA at all. If your employer does choose to contribute, their contribution typically won’t count towards your yearly limit no matter how much they contribute.

The Differences

You can’t have both of these plans at the same time, so if your employer offers an FSA but you’re also considering an HSA, you’ll want to keep these key differences in mind when you’re making your decision.

Qualifications

Compared to FSAs, HSAs have stricter eligibility requirements. To qualify for an HSA, you must have an HDHP. The HDHP has to be your only health insurance. Additionally if you are eligible for Medicare or are a claimed dependent on someone else’s taxes you can not open an HSA. On the other hand FSAs have to be set up by your employer, which automatically excludes self-employed or unemployed people. Your employer does have some qualifications they have to meet to be able to offer FSAs. For example they can only contribute to employee FSAs if they own less than 2% of the company. However, if they already offer these plans then there’s no other eligibility requirement on your end, all employees are eligible even ones without health insurance plans.

Annual contribution limits

Since contributions to these accounts are tax free they lower your taxable income. Because of this the IRS has placed limits on these plans. For FSAs the contribution limit is $3,050 as of 2023. For HSAs it’s $3,850 for individual plans and $7,750 for family plans.

Rollover rules

One of the biggest advantages of an HSA is that your funds roll over, meaning there are no time restrictions on using your funds. Since the account belongs to you, you get to decide when and how to use the funds. However for FSAs it’s not as simple. Unused funds are not automatically carried over into the new year. Since your employer owns the plan they decide what happens to the funds. Employers have 3 choices when it comes to rolling funds over:

• • Forfeiture – This means any unused funds will not roll over. Instead, they will be transferred to the employer.
  • Grace period – This is a 2 ½ month period after the plan year ends to use the last of the fund in the account, after this time frame, the funds then go to your employer.
  • Carryover- This allows employees to take $500 of the unused money over to the new year’s plan. Any funds left in the account after the $500 is carried over goes to the employer.

Changing contribution amounts

This is another point where HSAs are simple. You can contribute any amount you want at any time, you don’t have to keep the same contribution every time. Whereas with FSAs your contribution amount stays the same through the year. You can only change your contribution amount 3 times. First at open enrollment, when the plan renews you can decide to change your contribution amount for the new year. Next is if there is a change to your family situation such as a marriage, death, or birth you will be allowed to adjust the amount. Lastly, if you change employers when you enroll in your new employer’s health plan, assuming they offer one, you can select your new contribution amount since it’s an entirely new FSA.

Keeping your account when changing jobs

Unlike FSAs, HSAs follow you no matter how many times you change jobs because your account belongs to you. With FSA’s, they belong to your employer so unless you qualify for COBRA, you will no longer have access to your FSA if you leave your job.

Which Is Better?

If you qualify, the higher contribution limits and contribution rollover of HSAs make it the better option overall. HSAs are more flexible than FSAs, allowing you to save money over time for potential medical expenses. However, unless your job allows you to roll over $500 annually, your FSA balance will not build up over time. Depending on your employer’s decisions, unused funds are generally forfeited to your employer at the end of this year, meaning if you didn’t have many medical expenses for that year you could be losing money. 

However, most of the time choosing between them is more dependent on your situation rather than which one you actually prefer to have. This is because the decision will depend if your employer even offers an FSA and whether or not your health insurance plan is an HDHP. 

Getting Help With EZ

Both of these options can be excellent tax-free ways to save, invest, and pay for medical expenses, and EZ can help if you’re interested in HSAs. If you choose an HDHP, open an HSA as soon as you are eligible and begin contributing. Since these accounts continue to be one of the most effective ways to reduce expenses and improve your overall financial standing. To begin saving immediately, enter your zip code in the box below to receive free instant quotes. Or, contact one of our licensed agents at 877-670-3557.

With these questions in your pocket, you’ll be able to confidently compare health plans. Whether you’re selecting a plan for the first time, or if you’re thinking about changing your current plan, these questions are important to keep in mind.

How Much Does the Plan Cost?

You’ll want to carefully look over plan prices, not just the premium, you’ll want to know how much the other out-of-pocket costs will be as well. Premiums, deductibles, copays and other costs of health insurance all vary from plan to plan and state to state. So, comparing is key here to make sure you get a plan that fits within your budget. We’ve gone into a little more detail about each of the costs you’ll want to research below. 

Your Premium

This is the monthly fee you pay for your insurance company to provide you and your family with coverage. The cost of your premium will vary depending on a few factors. First, the majority of insurance companies will underwrite you before they insure you. Meaning they will collect all of your health data and use them to determine your “risk factor”. Other variables include your age, your lifestyle, and sometimes even where you live.

Your Deductible

Before your plan will cover your medical expenses, you have to first meet your deductible. For example, say your plan carries a $1,500 deductible and you need a surgery that costs $3,500. You will have to pay $1,500 and then your company should cover the remaining $2,000. Keep in mind, your premium will not count towards your deductible. The things that will count towards it are any bills you pay for hospital stays, surgeries, lab tests, anesthesia, doctor visits that aren’t covered with a copay, and medical devices such as pacemakers.

Your Copay or Coinsurance

When you visit the doctor or fill a prescription, you’ll pay a copay upfront. It’s a flat fee, typically between $10-$30. Each part of your health services may have different copays such as $30 per doctor visit or $20 per prescription, but each of those services will always have that same copay. For instance, if you injure your back and visit the doctor, or if your child’s asthma medication needs to be refilled, the copay amount – for that visit or medication will remain the same. 

Coinsurance is the portion of medical expenses you are responsible for after your deductible has been met. Coinsurance is a way of saying that you and your insurance company each pay a portion of the eligible costs that total 100%. For instance, if your coinsurance is 20%, you are responsible for 20% of the cost of your covered medical expenses. Your health insurance will cover the remaining 80 percent.

What Kind Of Coverage Do I Need?

After deciding your budget, the next question is about coverage. Do you have health conditions? Do you know you see the doctor often? Are you healthy? There’s a large variety of plans that will give you more coverage if you aren’t healthy, or less coverage if you are healthy. That way you don’t pay for coverage you don’t need, and you know the things you do need will be taken care of. 

Health Maintenance Organizations (HMOs) provide access to doctors within their network, whereas Preferred Provider Organizations (PPOs) provide access to a larger network at a higher cost. There are also 4 plan tiers available: Bronze, Silver, Gold, and Platinum. Each tier has varying prices with varying coverage. If you want a low monthly premium and are healthy, a Bronze or Silver plan is your best option. While Gold and Platinum plans have higher premiums but lower deductibles. Making them ideal for anyone with medical conditions that need more care.

Is My Current Doctor In The Plan’s Network?

One of the most common concerns while searching for health insurance is whether or not you can keep seeing the doctors you already have. If you have ongoing medical conditions, or simply just like your current doctor, the last thing you want to have to do is switch doctors. It means having to explain your entire medical history and probably retake tests you’ve already had done. It can also bring up an issue if your new doctor doesn’t agree with your old doctor’s diagnosis or treatments. Your doctor is definitely one of those situations where familiarity is important. When you’re shopping for health insurance, find out what the plan’s network looks like. The network isn’t just primary doctors either, it’s also hospitals, facilities, and specialists as well. You don’t want to find out too late that the hospital closest to you doesn’t accept your insurance.

Are There Extra Benefits or Perks?

This may seem small, but it can be the selling point between one plan over another. Some plans will offer things like dental and vision discounts, telehealth, gym memberships, etc. You’ll want to decide if you want the bells and whistles or if you don’t really care for them. These perks can be offered as “free”, but keep in mind the more benefits a plan has the more expensive your plan is likely to be.

Will My Plan Travel with Me?

If you travel frequently, whether for work or leisure, you should make sure your plan has the freedom and flexibility you’ll need, regardless of where you are when you need it. You’ll want to look at the network again, and the budget. Will you pay more for out-of-network facilities and doctors? If you do pay more, can you be reimbursed? If it’s Christmas and you’re four states away visiting family and you need the emergency room the last thing you want to do is worry about a giant medical bill.

Is My Medication Covered?

Two-thirds of adults in the U.S. use prescription medications, so there’s a good chance you will too, if you don’t already. It’s not uncommon for you to get caught up in the other details of your health plan and forget to look at the prescription drug coverage. These costs can rack up quickly, so be sure to look at the plan’s drug formulary before you enroll. The formulary is a list of prescription drugs that are covered as well as their associated costs. That way you can better budget for any medications you currently take, as well as any antibiotics you might need in the future.

Will This Plan Cover Alternative Therapies?

If you’re interested in alternative therapies (alternative medicine) you’ll want to make sure those will be covered as well. Some alternative medicine would be a chiropractor, having a home birth, or getting acupuncture. Different health plans handle these types of services differently. In some circumstances they can be covered similarly to your other health care. On the other hand, some plans might have minimal or no coverage for alternative therapies. If this type of care is important to you, make sure to look closely at the plan’s benefits in detail.

Who Can I Call With Questions?

Most people agree that, when it comes to health insurance companies, the worst part is the lengthy phone calls. There is typically a customer service line, but you’ll most likely deal with a lot of transfers or possibly be placed on hold for long periods of time. Some have direct numbers for agents to speak to you directly or chat services where you can virtually ask your questions. Most will even have a discussion forum where you can find the answers to some of your questions. The worst systems are the automated phone systems, where you have to listen to several menus and hope what you need is on the list. There’s a way to avoid all of that hassle and uncertainty though: giving one of EZs agents a call. 

EZ.Insure provides highly trained agents in your region who can answer all of the above questions and then some. You get to speak with a real person, -skip the automated line, and get all of -the information quickly. The best part? It’s free! We will assign you to your own personal agent who will search and compare all available plans in your area at no – cost. We make sure to find you plans that fit within your budget without sacrificing coverage needs. To get your instant free quotes today simply enter your zip code in the box below or give us a call at 877-670-3557 to speak to an agent directly.

And when it comes to deductibles, you actually have choices. You can choose a high-deductible health plan (HDHP) or a low-deductible health plan (LDHP). But what’s the difference between these types of plans?  This article will guide you through the specifics of HDHPs and LDHPs. As well as how to determine which type of plan will serve your needs most effectively based on your needs.

High Deductible Health Plans

A high deductible health plan (also known as a HDHP). As the name implies, is a type of health insurance policy that has a higher annual deductible than other types of healthcare plans. This difference can even be in the four-figure range. Meaning that you will most likely have to pay thousands of dollars out-of-pocket for medical care before your plan will begin to cover any expenses. 

With that being said, monthly premiums for these plans tend to be lower than for other plans. And you will still have routine preventive care covered in full before you meet your deductible. As with any ACA-approved plan. The actual deductible you will have if you choose a HDHP will vary depending on your plan and insurance company, but there is a minimum deductible amount for a plan to be considered a HDHP, which changes each year. For 2023, the minimum annual deductible for individuals is $1,500, while the minimum for families is $3,000.

Advantages of HDHPs

As mentioned above, if you choose a HDHP, you will have a plan with a high deductible. But lower monthly premiums. This means that if you know that you will most likely only use the plan for preventive care rather than more extensive medical treatment. You could save money by going with a HDHP. 

Other than lower monthly premiums, there is one other big advantage to HDHPs. You can open a health savings account (HSA) in conjunction with a HDHP; in fact, in order to have an HSA, you must have a HDHP. HSAs can be a great way to help pay for your out-of-pocket medical expenses. They are tax-advantaged accounts that can be used to pay for qualified medical expenses that your plan doesn’t pay for. Such as acupuncture and dental expenses. Your contributions to your health savings account are not subject to income tax. And they can be used to reduce the overall cost of your high deductible.

Disadvantages of HDHPs

The high cost associated with these plans is the most significant and obvious disadvantage of HDHPs. If you have a higher deductible, it means that you are responsible for paying a greater portion of your healthcare costs out-of-pocket before your plan begins to contribute. This may put a significant dent in your financial resources. Particularly if you are forced to deal with unanticipated problems relating to your health.

Low Deductible Health Plans

One of the most significant differences between a HDHP and a LDHP is that a low deductible plan typically has a lower deductible. But a higher monthly premium payment.

Because of their lower deductibles, this type of plan is typically chosen by people who see their doctor more regularly. And who need more medical care.  If this is the case for you, you might find that the higher amount you’re paying in monthly premiums is balanced out by the low deductible, since once you meet this lower amount, your insurance company will take care of your remaining costs. That could mean you’ll actually end up paying less out-of-pocket. In addition, LDHPs do not qualify for a health savings account (HSA), which is another difference between the two types of plans.

Advantages of LDHPs

Having a plan with a low deductible means you’ll have less to pay out-of-pocket if you need to access healthcare services more frequently, or if you have a true emergency or a catastrophic illness or injury, both of which can be very expensive. People who are older or who have a medical history that includes chronic conditions or illnesses may find that selecting a plan with a low deductible is the better option for them. Others who might benefit from this type of plan include:

• Women who are pregnant or who have the intention of becoming pregnant
• People who undergo a variety of specialized treatments or need expensive medications, such as those with cancer or on dialysis
• Any individual who is contemplating undergoing a surgical procedure within the next year

Disadvantages of LDHPs

Plans with low deductibles tend to have higher monthly premiums, since insurance companies will only cover a greater percentage of your care if you pay a higher premium. These premiums can feel like a burden each month, and if you don’t end up using your plan as often as you thought you might, you could start to feel like you’re wasting money.

Who Should Choose a High Deductible Health Plan?

As we pointed out above, a HDHP might be a good choice for you if you are healthy and anticipate having few to no healthcare expenses. In these circumstances, the lower monthly premiums that you would be paying for your “just in case” plan (which will also cover your preventive care), would save you money over a more expensive plan.

In addition, if you can’t afford a low deductible health insurance plan, you can still get yourself at least some level of coverage with a HDHP. And it’s important to have a plan, even if it has a high deductible, because health insurers negotiate rates with providers. This means you will pay less overall for products and services related to your health if you have health insurance than if you do not have health insurance. 

In addition, your high-deductible health plan (HDHP) will pay for necessary medical care, such as preventive services, if you purchase the plan on the individual market. But even if you have enough money to pay for a low deductible health plan, it may be worthwhile to consider a high deductible health insurance plan. Remember that if you have a high deductible health plan (HDHP), you can help to offset your out-of-pocket expenses with a health savings account (HSA).

Who Should Choose a Low Deductible Health Plan?

Again, a health insurance policy with a low deductible is likely to be beneficial to you if you are an older person, if you are not in good health, if you have a chronic condition. If you are planning to start a family, or if you simply make frequent use of your health benefits.

If you have costly health issues, purchasing a LDHP could save you money over the course of the year. Even with the higher premiums. If you switched to a HDHP, the amount you would save in premiums would be a much smaller fraction of the total amount you would pay in deductibles with your HDHP. And, frankly, many individuals find that it is simpler to pay a slightly higher amount on a monthly basis as opposed to a much larger sum all at once. Getting a low deductible health insurance plan might be the best choice for you if you don’t want to deal with the stress of potentially expensive medical care.

How to Choose

It is difficult to make a direct recommendation for a plan without knowing your unique financial situation and your health status. But we can offer the following advice to help you make a decision. Your best bet, though, is to speak to an EZ agent. Who can take your specific circumstances into account and find the best plan for you.

1.Look for discounts

 You might be eligible for assistance with your monthly premiums or cost-sharing expenses, depending on your income. So, before you write off a type of plan as too expensive. Ask an EZ agent if you qualify for subsidies or tax rebates.

2.Narrow down your choices

Think about the maximum amount of money you are willing to spend each month on your premium and go from there.

3.Look at additional features

When it comes to shopping for health insurance, deductibles are just one of many factors to take into account. Consideration should also be given to the size of the plan’s network, out-of-pocket maximums, and the structure of the plan. As well as the types of costs that are covered. After you have made a comparison of your expected medical costs for the year with the coverage options available to you. Look more closely at the plans you are considering. Ensuring that they provide the appropriate type of coverage for the amount of money you anticipate spending on healthcare.

4.Set your priorities

Your choice between a high deductible plan and a low deductible plan may come down to what you value more. The ability to save money on premiums if you are fortunate enough to not have many medical expenses. Or the peace of mind that comes from knowing that you won’t have to pay a deductible if you do end up needing more medical care. Doing some number crunching before making your decision might make things simpler for you.

Let EZ Help You

Do you need assistance comparing different plans and choosing the one that is best for your budget and healthcare needs? EZ.Insure is here to help! We will connect you with one of our dedicated, highly trained agents. Who will discuss all of your options with you and assist you in selecting the insurance policy that meets your needs, all at no cost to you. That’s right, there are no hidden fees associated with any of our services. EZ.Insure makes the entire process simple, easy, and quick. To get started, simply enter your zip code in the bar below. Or you can speak to an agent by calling 877-670-3557.

What Are Copays?

A copay is a predetermined amount of money you must pay when you use a medical service at the point of service. Health insurance policies typically specify copayment amounts in advance, and the amount will be different for each type of service. Examples of services that might require copayments include visits to your primary care physician, appointments with a specialist, prescriptions drugs, and emergency room visits. You might, for instance, have to pay $20 each time you see your primary care physician.

After you pay your copayment for a covered service, the insurance company will often pay for the rest. Especially for preventive care. For example, your annual check-up is a service your plan covers. So, you will only be responsible for your copay in this case. You should always check your plan’s benefits summary for specifics. But in general, copays are not included in the calculation of your maximum out-of-pocket costs.

What Is Coinsurance?

Most health insurance plans require that you pay coinsurance, or a percentage of the cost of care. With most plans, you’ll first have to meet your annual deductible. Then your insurance company will begin to cover your care, but you will have to split the cost. Your coinsurance share will depend on your plan, but you might have to pay 20% of each bill, for example. 

In addition, the coinsurance percentage you’ll have to pay may vary depending on the type of medical treatment you receive. For example, you might have to pay a different amount of coinsurance for things like office visits, tests, and medications. 

And, if you have a preferred provider organization (PPO) plan, you’ll most likely have to pay different amounts of coinsurance. Depending on whether or not the healthcare provider you see is in your plan’s network. For example, coinsurance for a primary care physician in your network could be 20%, while coinsurance for a primary care physician outside of your network could be 75%. That means you can lower your out-of-pocket expenses by trying to get care from in-network providers whenever possible. 

How Much Should You Expect to Pay in Coinsurance?

You won’t know exactly how much you’ll end up paying in coinsurance each year, but you can estimate your out-of-pocket costs by thinking about how much care you anticipate needing. The coinsurance you pay on that care will be a chunk of your out-of-pocket expenses, in addition to your monthly premium and your annual deductible. 

Your share of your medical costs will be determined by the type of plan you choose. You can choose from Bronze, Silver, Gold, or Platinum plans, each of which will require that you pay a different percentage of your medical costs:

• Bronze – 40/60, You pay 40% while your insurer pays the remaining 60%
• Silver – 30/70, 30% is your responsibility while your insurer pays 70%
• Gold – 20/80, you pay 20% and your insurer covers 80%
• Platinum – 10/90, your insurer pays 90% while you cover only 10%

How Copayments and Copays Work

As pointed out above, a copay is a predetermined amount that you have to pay for a covered service at the point of service, but coinsurance is the percentage of the total bill that you are responsible for. Both are some of the out-of-pocket costs of health insurance, but they function very differently. The difference between a copay and coinsurance can be broken down as follows:

• Copayments are a set price you pay for services. You are responsible for the copays before and after you’ve met your deductible 
• Coinsurance is a percentage of your medical bills you have. Coinsurance is only charged after you’ve met your deductible for the year.

What this means is that a $20 copay will always be $20. But your 20% coinsurance fee will vary with the price of the service. And these costs, as always, will vary depending on the plan you choose. In general, though, your copayments and coinsurance will be lower if you choose a plan with higher premiums.

Copay and Coinsurance Example

To make things a little clearer, here’s a further example of how copays and coinsurance work: Let’s say your health insurance plan has a $3,000 deductible, $50 copays for specialists, 80/20 coinsurance, and a $6,000 out-of-pocket maximum on an individual plan (and you have no dependents covered by your plan). This $6,000 maximum means that once you pay that amount in covered medical expenses in a given year, your insurance company will begin to cover everything, and you will no longer have to pay coinsurance. 

Now let’s say you go in for your free annual checkup (a preventative service) and bring up the fact that your shoulder has been bothering you lately. Your primary care physician refers you to an orthopedic surgeon for further evaluation. When you see this specialist, you will pay your $50 copay at the point of service.

The consulted specialist suggests an MRI to evaluate your shoulder pain. The price of the MRI is $1,500, and since you haven’t met your deductible for the year, you will have to pay the whole bill for this test. The MRI finds that you have torn your rotator cuff and will require surgery to repair it. The price tag for this operation is $7,000. After spending $1,500 on the MRI, you will have to pay $1,500 more in order to meet your $3,000 deductible before your insurance will cover any of the surgical costs. That leaves $5,500 to pay for the surgery, and since you have an 80/20 plan, your 20% coinsurance payment would be $1,100. 

With meeting your deductible and paying your coinsurance and copayment, the total cost of repairing your torn rotator cuff would be $4,150. But remember, in this scenario, your plan has a $6,000 out-of-pocket maximum, which you would be close to meeting after this surgery.

What Should You Look for in a Plan?

Since everyone’s financial situations and requirements for health insurance vary, there is no one plan that will work for everyone. But when shopping for a plan, there are some considerations that can help narrow down your options.

For example, if you’re looking at a plan with lower monthly premiums, you’re most likely going to have a higher coinsurance percentage. Take two health care plans with different monthly premiums of $200 and $450 as an illustration. These two plans may have 30% and 20% coinsurance for ER visits, respectively. So, when looking at plans with lower premiums, you should always consider that your out-of-pocket expenses, including your coinsurance payments, might be higher.

And when it comes to the copayments included in the plans that you are looking at, keep in mind that copayments are typically not applied toward meeting deductibles. You should look into plans with lower copays if you anticipate spending a lot of money on prescription drugs. Or making multiple trips to the doctor each year.

In-Network vs Out-Of-Network

As mentioned above, some plans have different deductibles, copayments, and maximum out-of-pocket expenses if you see an in-network healthcare provider than if you see out-of-network providers. This is because doctors and hospitals that are part of your plan’s network have agreed to provide you with care at reduced costs. 

These reduced costs mean that it’s important to seek care from a provider who is part of your insurance’s network if at all possible. And when looking at plans, make sure your preferred doctors and hospitals are included in the plan’s network. If you find that you are frequently seeing out-of-network providers with the plan you have. You might want to make a change to your plan during the next Open Enrollment Period. Speak to an EZ agent about your options.

FAQs

• Does coinsurance apply before I meet my deductible?

No, it doesn’t. If you have a 20% coinsurance, they will only begin to cover their 80% after you’ve met your deductible.

• Do all health insurance plans have copays and coinsurance?

No. You may not be required to pay a copayment for certain medical services with some plans. These plans, however, typically have higher monthly premiums. And there are also catastrophic health plans, for example, with very high deductibles and no coinsurance at all.

• Are copays and coinsurance tax deductible?

If your out-of-pocket medical expenses exceed 7.5% of your AGI, you may be able to claim a tax deduction for all of your medical expenses. Including your copays and coinsurance. The excess of your healthcare costs over 7.5% of your adjusted gross income is tax deductible.

• Do copayments and coinsurance count toward out-of-pocket maximums?

Your out-of-pocket maximum includes not only your deductible, but also any copays or coinsurance payments you may have made. Your regular premium payments don’t count toward your maximum.

• Is it better to have a higher or lower coinsurance percentage included in your plan?

A lower coinsurance percentage means you’ll have to pay less out-of-pocket for covered medical services. But if you have a lower coinsurance percentage, you might have a higher deductible and premiums. 

Conclusion

When you are searching for a health insurance plan, the plan descriptions will always include the premiums (the amount you pay on a monthly basis to maintain the plan), deductibles, copays, coinsurance, and out-of-pocket maximums. Pay close attention to all of these costs, not just the plan’s premiums. So you can get a feel for the true amount you’ll be paying for your healthcare.

If you are generally healthy, a cheaper plan that has higher deductibles could work for you. However, if you expect to have significant healthcare costs, it may be worth it to pay higher monthly premiums for a plan that will cover more of those costs.

EZ Can Help

If you need help finding the right plan for you, EZ.Insure is here to help. We can quickly evaluate all of the health insurance plans in your area. Your personal agent will help you sort through the various plans available to you. And explain all of the costs that come with each one. And the best part is that all of our services are completely free! To get your free quotes, simply enter your zip code in the box below, or give us a call at 877-670-3557.

So, the first thing you should do if you’re in the market for individual health insurance is familiarize yourself with these tiers. Which are each named with a different metal type (Platinum, Gold, Silver, and Bronze). These different tiers do not indicate differences in quality of care. But in the percentages that you and your health insurance company will pay for your care.

In the sections that follow, we’ll break down the various health insurance metal tiers, as well as explain how to find out if you’re eligible for cost-sharing subsidies to help you choose the best plan for you and your family.

Health Insurance Plan Expenses

Before we get into the individual tiers, let’s take a look at the different expenses associated with all plans. There are five primary expenses you should be aware of, and they change from plan to plan. Make sure that you have accounted for these expenses in your plan’s budget.

Premiums

In order to maintain insurance coverage, you’ll have to pay a monthly premium (or yearly premium if you prefer to pay in a lump sum). Premiums for plans will vary widely, but generally speaking, Bronze plans have the lowest premiums, followed by Silver plans, Gold plans, and Platinum plans. 

Copays

A copay is a fixed amount that you will pay at the time of service for a medical service, or to see a doctor or specialist. 

Deductible

Your policy’s deductible is the amount you’ll be responsible for paying before your insurance company begins covering any of your expenses. If your policy has a $1,500 deductible, for example, you will be responsible for paying that amount on covered care before your insurer begins paying for anything.

Bronze plans typically have the highest deductibles, meaning you’ll have to pay more out-of-pocket before your insurance kicks in. A Bronze plan’s deductible may be nearly twice as high as that of a Silver plan. Platinum plans typically have the lowest deductibles.

Coinsurance

Even after you’ve met your insurance plan’s deductible, you will most likely still have to pay a portion of your medical bills out-of-pocket, known as your coinsurance. A common coinsurance percentage is 20%, which means that once your deductible has been met (or until your out-of-pocket maximum has been reached), your insurance will cover 80% of your medical expenses, and you will pay the remainder. You can expect to pay the highest coinsurance for a Bronze plan.

The cost-sharing structure of the metal tiers is often misunderstood as coinsurance. Coinsurance is not the percentage that your Bronze plan covers (on average, 60% of consumer costs). All of your out-of-pocket costs (copays, deductible, and coinsurance) are included in the cost-sharing percentage of a metal tier.

Out-of-Pocket Maximum

While this isn’t technically an expense, it’s important to note that ACA-plans have what’s known as an out-of-pocket maximum. This means that once you pay a predetermined amount in healthcare expenses out-of-pocket, your  insurance will begin to pay 100% of covered expenses. In 2023, the maximum out-of-pocket expense for an individual plan is $9,100, while the maximum for a family plan is $18,200.

The “Metal Tiers”

All plans sold on the Health Insurance Marketplace are placed into one of four coverage tiers established by the Affordable Care Act. You’ll most likely see these four categories referred to as “metal tiers” or “health coverage tiers.”

Don’t worry though, as we pointed out above, these metal tiers do not indicate differences in the quality of care you receive with these plans. These tiers only indicate how much of your healthcare costs you and your insurance company will be responsible for. 

Plans were required by the ACA to begin classifying themselves in four actuarially determined categories: 60%, 70%, 80%, and 90%. This was done as part of the design process for the metal tiers and is meant to help you compare plans. Since these percentages indicate how much of your medical costs your insurance company will pay. Large group plans, such as those provided by an employer, are exempt from the tier requirements. But must have an actuarial value of at least 60%.

Remember, the cost of your plan always includes a number of factors. Like your monthly premiums, your annual deductible, copayments, and coinsurance. The metal tier you choose will dictate how much you pay for each of these. So let’s take a closer look at what this means for each metal tier.

Bronze

Bronze plans have the lowest monthly premiums of any plan type, but that doesn’t mean they are the cheapest plans. You will be responsible for a lot more of your care out-of-pocket if you have a Bronze plan. With these plans, your insurance company will cover 60% of your medical expenses. So, you will be responsible for the remaining 40%. Additionally, annual deductibles (the amount you are responsible for paying before your insurance plan kicks in to cover medical expenses) for these plans can be in the thousands. 

So who are these plans aimed at? If you don’t anticipate frequent use of medical services, but still want to be covered in case of something like a serious illness or injury, a Bronze plan may be a good fit for your budget. But the high deductibles and coinsurance of these plans mean that you’ll have to pay a hefty chunk of your bill for even minor medical care out-of-pocket.

Silver

Silver plans are the most moderately priced plans. With these plans, your premiums will be a bit higher than those of Bronze plans. But you will pay 30% of the total cost of your medical care out-of-pocket, and your insurance company will cover the remaining 70%. In addition, the deductibles for Silver plans are lower than they are for Bronze plans.

So, if you’re willing to pay a little more for your premiums than you would with a Bronze plan, but want more of your routine medical expenses covered. Silver plans are a great choice because of their lower deductibles. 

Gold

Gold plans have higher premiums than either Bronze or Silver plans do. But you will pay less out-of-pocket for medical services. If you have a Gold plan, your insurance company will pay for up to 80% of your medical expenses. Meaning you will only have to pay for the remaining 20%. 

This is the best plan for you if you know you’ll be needing a lot of medical attention. Because it provides more comprehensive coverage, as well as lower deductibles. The higher monthly premiums will balance out, once you add up what you would have to pay for out-of-pocket with a lower tier plan.

Platinum

Platinum plans have the highest monthly premiums of any tier, but in exchange, they have the lowest deductibles and coinsurance. Your insurer will cover a whopping 90%  of your medical bills with a Platinum plan. And you will only have to pay the remaining 10% out-of-pocket. 

Just like with Gold plans, Platinum plans are a good option if you know you’ll be needing extensive medical care.

How Cost-Sharing Works

The term “cost sharing” is used to describe the splitting of healthcare expenses between you and your health insurance company. In fact, the name says it all. You share your medical costs with your insurer, like in the 30/70 split of a Silver plan. This means that you aren’t stuck paying for all of your medical bills on your own. But your insurer also expects that you cover a sometimes-significant portion of your care. 

But, while the metal tier you choose will determine your cost-sharing percentage, your annual health care costs will be determined by the specific services you use and the specifics of your individual plan. For example, if you have a Bronze plan and you avoid all medical care for an entire year, only going in for an annual checkup. You will be responsible for less than 60% of your medical expenses for that year. However, if you get seriously ill and need surgery. You may end up paying for more than 60% of your care out-of-pocket. 

How To Enroll

You can only enroll in an ACA metal tier plan during the period known as “Open Enrollment,”. Which begins on November 1 and ends on January 15 (in most states). During this time, you can also make changes to an existing plan. When you purchase a plan during the Open Enrollment Period, or OEP,  your plan will go into effect on January 1 of the following calendar year.

Outside of the OEP, the only way to purchase or switch health plans is if you qualify for a  Special Enrollment Period (SEP). You will need to experience a  qualifying life event (QLE) in order to be eligible for one of these SEPs. QLEs include most significant transitions in your life, such as getting married, having a child, or changing careers.

EZ Can Help

Working with an EZ agent could mean saving hundreds of dollars on your premiums. Since we can search for plans both on and off the market for the best possible rates. Not only that, but we will also find any rebates for which you are eligible. And we won’t just help you find the best plan for you. We’ll also be here to support you after you make your purchase. For example, we’ll assist you in communicating with your insurance company regarding claims and policy renewals. To get started, simply enter your zip code in the box below. Or call one of our licensed agents at 877-670-3557.

Premiums

Like a Netflix or Spotify subscription, premiums are a monthly payment you make to maintain a service. In this case your health insurance plan. If you purchase an individual plan on the Health Insurance Marketplace, you will pay your premiums in their entirety. But you might be eligible for subsidies or tax rebates. If your employer offers a group health plan, the cost of your health insurance premiums may be partially or entirely covered by your employer.

How much you pay in premiums will vary based on several factors. Such as the policy you choose, the number of people in your family, and the insurance company you go through. In addition, when determining your premium, insurance companies may take into account factors such as your age, where you live, and whether or not you smoke cigarettes. For instance, because healthcare costs are assumed to increase with age, premiums for older adults are higher.

Individual vs. Family Health Plan Premiums

Premiums for individual health plans and family health plans function in the same way. There is only one payment required each month, so the cost itself is the only difference. The cost of your premium will be higher the more people who are covered by it. But, if you do the math, you might find that you’re paying less per person for a family plan than you would if you all had your own separate plans. 

The only time this might not be the case is when someone in your family has significant health issues and another person rarely sees the doctor. In this case, it might be better to find plans that have lower premiums and higher deductibles for the healthier family member. And a plan with higher premiums and a lower deductible for the family member who needs more medical care. Let’s see why by taking a closer look at how deductibles work. 

Deductibles

In most cases, your insurance plan will have an annual deductible. Which you will have to meet before your health insurance begins paying for any of your medical care costs.  “Meeting” your deductible means that you will have to pay that amount in covered expenses to get coverage for anything other than preventive care. So, if your plan has a $2,000 deductible, for example, you’ll have to pay $2,000 out-of-pocket for things like lab work, minor surgeries, tests done at your doctor’s office, etc., and then your insurance plan will begin covering those things. 

There are a variety of ways deductibles can work, and which medical expenses will count towards meeting them. Health insurance policies for individuals and families may include a deductible structure. In which the insurance company is not obligated to pay for services until the deductible has been met. But in some cases, a plan may cover some medical expenses before the deductible is met while excluding others. In addition, certain expenses like copayments won’t count towards your deductible.

Individual vs. Family Deductibles

Health insurance deductibles can either be applied per person or per family. The way individual deductibles work is fairly straightforward, while family deductibles can be a bit  more complicated.

• Individual – First, the easy part. If you have an individual health insurance policy, the money you spend on qualified medical expenses will count toward meeting your deductible. Once your plan’s deductible is met, you and your insurance company will begin dividing the remaining costs. Meaning you will pay what’s known as “coinsurance,” or a certain percentage of each bill. You’ll do this until you reach your policy’s out-of-pocket maximum.
• Family – This is where things can get confusing, because your plan might have both an individual deductible and a family deductible. There are two main categories of family deductibles: embedded and aggregate. An aggregate deductible works the same as an individual deductible. Your plan will have one deductible, and everyone on the policy will be paying towards it. 

Embedded deductibles, though, is where the confusion sometimes comes in. With an embedded deductible plan, there is both a family deductible and an individual deductible. So, each member of the family has a separate deductible in addition to the family’s deductible. Once a family member’s deductible is met, the insurance policy begins covering 100% of that person’s healthcare costs. Everyone else in the family will still have to meet their own deductible after that member’s deductible is met. 

In addition, there is also a family deductible with these plans. And all family members will begin to have their expenses covered once the family deductible is met. Everyone will have to only pay their coinsurance until the out-of-pocket maximum is reached, once the family deductible is met.

Costs

The cost of your premiums and the amount of your deductible will depend on a variety of factors. It is difficult to give an accurate estimate of what you’ll pay without knowing your unique circumstances. Wut we can say that the average monthly premium price in the country is $456 per month. 

Check out our state-by-state health insurance guides to learn more about how the health insurance market is regulated in your state. And to get a baseline estimate of the costs. You can also learn more about the health insurance plans that are available in your state. As well as ways to reduce the cost of your coverage.

As for deductibles, the average nationwide deductible amount depends on the metal tier you choose for your plan: Bronze, Silver, Gold, or Platinum. Keep in mind, lower deductibles mean a higher premium.

The average annual deductible amount for each tier is as follows:

• Bronze – $7,482
• Silver – $4,890
• Gold – $1,650
• Platinum – $745

How Premiums and Deductibles Work Together

Insurance premiums and deductibles are interrelated costs. Your plan’s premiums will be higher if the deductible is lower, for example. So, generally, your plan will either have a higher monthly premium with a lower deductible, or a lower premium with a higher deductible.  

If you’re wondering which type of plan would be better for you. Consider that a higher premium with a lower deductible would be more appropriate for someone who has a pre-existing condition and needs to see the doctor frequently. And if you don’t often see the doctor or generally spend a lot on medical services, having a higher deductible won’t be as much of an issue for you. And you might be better off spending less on your premiums.

FAQs

• How can I lower my premiums?

If you have individual coverage, and your household’s annual income is less than or equal to 400% of the federal poverty level, you might be eligible for subsidies or tax rebates. Which can lower the price of your premiums. If you have group health insurance through your employer, they might offer you reduced health insurance premiums or other incentives if you are able to meet certain health and wellness criteria.

• What will increase my premiums?

Your health insurance premiums may increase for a variety of reasons. Including but not limited to inflation, adding family members to your plan, and relocating to an area with a higher cost of living. It’s also possible that your monthly health insurance premiums will go up if you opt for a plan with more generous benefits. Consider the policy’s premium in light of its benefits before making your decision.

• Are premiums tax deductible?

If you have a plan through either the federal or state Health Insurance Marketplace, your premiums are tax deductible. If you’re self-employed, health insurance premiums are tax deductible. And you may also be able to deduct the premiums you pay for long-term care insurance. Before submitting a tax deduction claim, you may want to consult a tax expert.

• Is a high or low deductible plan better for me?

If you do not anticipate having many medical expenses during the next plan year, selecting a health insurance policy that has a high deductible could give you the best value. When you anticipate having a lot of medical expenses in the near future, such as if you plan on having a baby, selecting a plan with a low deductible could help you get the most value out of your coverage.

• What does “no-charge” deductible mean?

If you have a plan with a “no-charge” deductible, your plan will pay 100% of eligible medical expenses after you meet your deductible for the year.  No-charge deductibles tend to be higher. But if you plan on using a lot of medical services for the year, it might balance out when you are no longer required to pay anything out-of-pocket.

How EZ Can Help

EZ.Insure provides access to local, highly trained insurance agents. Who will shop around for the best policy at the most affordable price. We can save you hundreds of dollars a year by searching both on and off the Marketplace for a plan that fits your needs. We can also find out if you’re eligible for any local discounts. And then apply them to your plan for you. And the best part is that we do all of this for free! To find out how much you could be saving, simply enter your zip code on the box below for free, instant quotes. Or call us at 877-670-3557 to speak to an agent who can answer all of your questions and find you the perfect plan.