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How to find a health plan that’s right for you

 

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.

Learn more about how metal tiers break down costs

To help you pay for coverage and/or care, you may get federal financial assistance if you're a U.S. citizen or legal resident. The amount of help is based on the size of your family, your income, and the cost of coverage in the health benefit exchanges.

You may qualify for federal financial assistance, and in some Markets additional state financial assistance, even if you haven't qualified in prior years.

For general income guidelines and to see if you qualify for federal financial help, start a quote. There, you can also compare plans, calculate your rate, or apply online.

Learn more about subsidies

Getting you connected with a doctor who suits your individual needs is our top priority. We know how important it is to find a doctor who's right for you. When you have a doctor you connect with, it’s easier to stay healthy.

To choose or change doctors at any time, for any reason, browse our online profiles by region.

Find top-notch doctors, specialists, and pharmacies near you

In general, you can only change or apply for health care coverage during the yearly open enrollment period (OEP). But if you have a qualifying life event, you may be able to change or apply for coverage for a limited time (the special enrollment period).

Generally, a special enrollment period (SEP) lasts 60 days after the triggering event occurs. That means if you've experienced a qualifying life event, you have 60 days from the day of the qualifying life event to change or apply for health care coverage for yourself and/or your dependent. In some situations, if you are aware that you will lose coverage or your eligibility for coverage will change in the future, you may be able to apply for new coverage 60 days before the loss of coverage.

Examples of qualifying life events are:

  • Loss of minimum essential health coverage
  • Gaining, becoming, or losing a dependent or death of a subscriber or a dependent
  • Permanent relocation with access to new plans
  • Change in income changing your eligibility for federal assistance
  • Changes in employer health coverage making you eligible for a premium tax credit

Learn more about qualifying for a special enrollment period in your state

Health care is full of industry-speak. Without knowing the basics, it’s hard to understand how things work. Look up the key terms you need to know as you navigate the world of health care.

Explore our list of key terms


 

 
How does health insurance work?

Simply put, health insurance works by helping you pay for medical care and services, so you don’t have to pay all your health care costs on your own. Choosing the right coverage is important — and there’s a lot to consider.

Learn more about how health coverage works

What to know about health plan costs

This 4-part series covers health plan costs, including setting a budget, tips for saving money, and understanding medical care costs.

Learn more about health plan costs

 

What is Kaiser Permanente?

We offer care and coverage together to support your total health — and simplify your entire health care experience. See how it works, why it makes us different, and how it can benefit you.

Learn more about health coverage at Kaiser Permanente


In California, KFHP medical plans are offered and underwritten by Kaiser Foundation Health Plan, Inc., One Kaiser Plaza, Oakland, CA 94612 • In Colorado, all medical plans are offered and underwritten by Kaiser Foundation Health Plan of Colorado, 10350 E. Dakota Ave., Denver, CO 80247 • In Georgia, all medical plans are offered and underwritten by Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Rd. NE, Atlanta, GA 30305 • In Hawaii, all medical plans are offered and underwritten by Kaiser Foundation Health Plan, Inc., 711 Kapiolani Blvd., Honolulu, HI 96813 • In Oregon and southwest Washington (Clark and Cowlitz counties), all medical plans are offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 • In Washington (except Clark, Cowlitz, and certain other counties), all medical plans are offered and underwritten by Kaiser Foundation Health Plan of Washington, 1300 SW 27th Street, Renton, WA 98057 • In Maryland, Virginia, and the District of Columbia, all medical plans are offered and underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., 2101 E. Jefferson St., Rockville, MD 20852