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How to budget for affordable health coverage
Before you decide on a plan, you’ll need to think about:
- Your health and how often you need care
- How much coverage you need
- How much money you’re willing to spend
- How different health plans work
- What each plan offers beyond the basics
Understanding your total health care costs is key to getting the most out of your plan and avoiding potentially expensive surprises.
Types of plans
We offer a variety of plans to help fit your needs and budget. All of them offer the same quality care, but the way they split the costs is different. Not all of these plans are available in all states.
- Virtual plans: In some markets, we offer Virtual Plans where your monthly premium is lower, and you’ll start most care with a virtual visit. Connect to care how you want – choose from 24/7 online chat or advice phone line, e-visit, scheduled video visit, phone appointment, or email for nonurgent issues, all at no additional cost. You’ll get the care and prescriptions you need or help finding in-person care.
- Copay plans: Copay plans are the simplest. You know in advance how much you’ll pay for care like doctor visits and prescriptions. This amount is called your copay. Your monthly premium is higher, but you’ll pay much less when you get care.
- Deductible plans: With a deductible plan, your monthly premium is lower, but you’ll need to pay the full charges for most covered services until you reach a set amount known as your deductible. Then you’ll start paying less – a copay or coinsurance. Depending on your plan, some services, like office visits or prescriptions, may be available at a copay or coinsurance before you reach your deductible.
- HSA-qualified high deductible health plans: HSA-qualified deductible plans are deductible plans with a special feature. With this plan, you can set up a health savings account (HSA) to pay for health costs like copays, coinsurance, and deductible payments. And you won’t pay federal taxes on the money in this account. You can use your HSA anytime to pay for care, including some services that may not be covered by your plan, such as eyeglasses or adult dental. And if you have money left in your HSA at the end of the year, it will roll over for you to use the next year.
The 4 metal tiers of plan types and how they break down
Getting to know the 4 coverage levels — also called metal tiers — within those plan types will help you understand:
- What’s covered
- What you’re responsible for paying
- What’s the best fit for your health care needs
It’s important to know that the metal tiers are only based on how you and your health plan split costs — they have nothing to do with the quality of care you’ll receive.
- Bronze ($): Lowest monthly premium | Highest deductible | Highest out-of-pocket costs for care
A good choice for healthy people who rarely see the doctor and want a low-cost way to protect themselves in case they occasionally get injured or sick.
- Silver ($$): Moderate monthly premium | Moderate deductible | Moderate out-of-pocket costs for care
A good choice for generally healthy people willing to pay a little more each month to have fewer out-of-pocket expenses before your health plan starts covering the cost of care.
- Gold ($$$): Higher monthly premium | Lower deductible | Lower out-of-pocket costs for care
A good choice for people with dependents and who use health care services regularly throughout the year.
- Platinum ($$$$): Highest monthly premium | Lowest deductible | Lowest out-of-pocket costs for care | Not offered in all markets
A good choice for people with known health issues who have frequent specialty care needs, tests, and prescriptions.
