How to Choose a Health Insurance Plan Through Healthcare.gov

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47 percent of young adults between the ages of 18 and 36 do not have health insurance, usually due to cost, according to a 2013 Harris Poll.

What’s more, medical bills are often the cause of personal bankruptcy.

However, anyone who is a U.S. citizen living in America and not incarcerated can access the Health Insurance Marketplace listed on Healthcare.gov and sign up for coverage.

Most people who use Healthcare.gov do not have employer-offered health insurance because they work for small companies. Or, they’re freelancers or entrepreneurs.

And even if your company does offer insurance, you can get quotes through the marketplace to see if you can get a more affordable plan.

However, navigating the marketplace and website can be overwhelming for first-timers. That’s why we’ve created this guide to help you along the way.

How to choose health insurance

Healthcare.gov offers a wide range of plans, from bare bones versions to premium options that are much more expensive.

Here are a few factors to keep in mind when deciding on a health care plan that’s right for you.

Insurance terms

Before you start comparing plans, it’s important to understand key terms so you can choose a plan that meets your needs.

Your premium is the monthly bill you pay for your health insurance plan. Whether you go to the doctor or not, or receive any prescriptions, you owe the premium every month.

Your deductible is the amount you have to pay before your insurance begins to pay anything. Plans with a higher premium have lower deductibles.

A high deductible will give you a lower monthly bill, but you will end up paying more of your own health expenses in the long-run.

Copayments and coinsurance are the amounts you pay for medical care after you meet the deductible. For example, you may owe $20 at the doctor’s office for a follow-up visit.

You need to think about what is most important to you: a low deductible or a low premium. That will help you decide which plan is the best for you financially.

Four insurance categories

Healthcare.gov offers four overarching categories: bronze, silver, gold, and platinum. The different groups are determined by their overall costs and are not related to the quality of care.

Bronze plans

Under a bronze plan, the insurance company covers 60 percent of your medical expenses and you cover 40 percent.

These plans tend to have the lowest premiums. However, when you do need medical care, you pay more out of pocket.

Ultimately, they are a good choice for people who are healthy and who only need protection for medical emergencies.

Silver plans

With a silver plan, you pay for 30 percent of your medical bills and the insurance company covers 70 percent.

Silver plans cover more of your routine care and the costs are moderate compared to higher-tier plans.

Gold plans

Insurance companies cover 80 percent of your medical bills under a gold plan, leaving you responsible for 20 percent.

They have a high monthly premium, but a lower deductible. If you have a lot of medical needs, a gold plan may be a good option.

Platinum plans

Under a platinum plan, you cover just 10 percent of your medical expenses. The insurance plan covers the rest.

Your deductible is very low, so your insurance kicks in quickly to cover the costs of your care.

These plans are wise choices for people who have a lot of health care needs and who want the majority of their costs covered.

Think about how much care you usually need in a year and how often you go to the doctor before selecting a tier.

PPOs, HMOs, POS, and EPO

When considering how to choose a health insurance plan, it’s important to understand the different acronyms for plans and network types.

Next to your options in every category, you’ll see letters like PPO, HMO, POS, and EPO. Each acronym refers to plans that determine what doctors you can go to.

Preferred Provider Organization (PPO)

Under a PPO, you pay less if you use the insurance company’s network of doctors and hospitals. But you can use healthcare providers outside of the network if you choose, without a referral, for an extra cost.

Essentially, PPOs give you more flexibility in what doctors you see.

Health Maintenance Organization (HMO)

HMOs limit you to providers within the network unless it’s an emergency. Out of network care is not covered, and you need a referral to see a specialist.

Point of Service (POS)

With a POS, you pay less if you use in-network doctors. But you do need a referral to see specialists.

Exclusive Provider Organization (EPO)

Services are only covered under an EPO plan if you use doctors and health care providers within the network.

Remember, when you are choosing between plans, you will see that each plan offers a provider directory. So if you have a doctor you love, check and see if they are within the network to ensure your insurance will cover your visits with her.

Formularies

One other major factor in deciding how to pick health insurance is the insurance formulary. If you have medical conditions that require you to take medication, the formulary is a big deal.

The formulary is a list of drugs that the insurance provider covers under a particular plan. Some medicines are covered under certain plans but not others. Or, they may be more expensive under some plans.

Ultimately, each plan listed will have a link to the formulary. So you can look up your specific medications to see if a specific insurance plan covers them.

Dental and Vision

Healthcare.gov offers both vision and dental plans as optional add-ons for adults.

If you opt out of signing up for either add-on, the government will not penalize you. You are only required to have general health insurance.

Plans range from basic options that include routine cleanings and X-rays to more expensive versions that cover more intensive procedures.

Adding on dental and vision can add to your monthly premiums. So be sure to consider your unique needs and how often you visit the dentist or ophthalmologist before signing up.

What you need to enroll

You can enroll online, but you will need to have certain information on hand.

To complete your health insurance application on Healthcare.gov, make sure you have the following:

  • Information about your household size
  • Home and mailing address for each person applying
  • Information about each person, including birthdates
  • Social security numbers
  • Information on how you file your taxes, such as your tax returns from last year
  • Employer and income information
  • An estimate for your 2017 income
  • Policy numbers for your current insurance policies
  • Plan ID from 2016 (if you had insurance)

What changes are there for 2017?

When thinking about how to choose a health insurance plan, keep in mind the following changes for 2017.

The open enrollment period starts on November 1 and ends on January 31, 2017.  So if you want your coverage to start on January 1 of the new year, the deadline to enroll is December 15. If you apply after that date, your insurance will not kick in until February.

If you do not enroll during the open enrollment period, you will not be able to get health insurance. And, you will owe a penalty for each month you do not have coverage, which is pretty steep.

The only exception to paying the penalty fee is if you had a major life event, like you lost your job, got married, or had a baby. Then you can enroll in a plan through a special enrollment period.

The penalty fee is either 2.5 percent of your income, or one fine per person, whichever is higher. The per person fine is $695 and $347.50 for every child under 18 who does not have insurance.

Keep in mind that you can get a basic bronze plan through Healthcare.gov for less than the penalty. Essentially, getting insurance is more cost-effective than paying the fee.

More than 85 percent of people who enrolled in a plan through Healthcare.gov qualified for a subsidy from the government last year, according to a report last year from the U.S. Department of Health and Human Services.

Subsidies ultimately make insurance more affordable for plan holders who qualify for them.

Enrolling in a plan

Figuring out how to choose health insurance can be frustrating and overwhelming. However, health insurance provides an essential safeguard for your physical health and financial well-being.

See for yourself how you can apply for a plan and pay for your premiums entirely online.

Or, if you need more help choosing the best plan for you, you can also get free help over the phone or in person from trained navigators and assisters.

Just visit Healthcare.gov’s local help section and type in your zip code to find free assistance services in your area.

Interested in refinancing student loans?

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1 Important Disclosures for Laurel Road.

Laurel Road Disclosures

  1. VARIABLE APR – APR is subject to increase after consummation. The variable interest rates are based on a Current Index, which is the 1-month London Interbank Offered Rate (LIBOR) (currency in US dollars), as published on The Wall Street Journal’s website. The variable interest rates and Annual Percentage Rate (APR) will increase or decrease when the 1-month LIBOR index changes.

2 Important Disclosures for SoFi.

SoFi Disclosures

  1. Student Loan RefinanceFixed rates from 3.999% APR to 7.804% APR (with AutoPay). Variable rates from 2.480% APR to 7.524% APR (with AutoPay). Interest rates on variable rate loans are capped at either 8.95% or 9.95% depending on term of loan. See APR examples and terms. Lowest variable rate of 2.480% APR assumes current 1 month LIBOR rate of 2.07% plus 0.91% margin minus 0.25% ACH discount. Not all borrowers receive the lowest rate. If approved for a loan, the fixed or variable interest rate offered will depend on your creditworthiness, and the term of the loan and other factors, and will be within the ranges of rates listed above. For the SoFi variable rate loan, the 1-month LIBOR index will adjust monthly and the loan payment will be re-amortized and may change monthly. APRs for variable rate loans may increase after origination if the LIBOR index increases. The SoFi 0.25% AutoPay interest rate reduction requires you to agree to make monthly principal and interest payments by an automatic monthly deduction from a savings or checking account. The benefit will discontinue and be lost for periods in which you do not pay by automatic deduction from a savings or checking account. *To check the rates and terms you qualify for, SoFi conducts a soft credit inquiry. Unlike hard credit inquiries, soft credit inquiries (or soft credit pulls) do not impact your credit score. Soft credit inquiries allow SoFi to show you what rates and terms SoFi can offer you up front. After seeing your rates, if you choose a product and continue your application, we will request your full credit report from one or more consumer reporting agencies, which is considered a hard credit inquiry. Hard credit inquiries (or hard credit pulls) are required for SoFi to be able to issue you a loan. In addition to requiring your explicit permission, these credit pulls may impact your credit score
  2. Terms and Conditions Apply: SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet SoFi’s underwriting requirements. Not all borrowers receive the lowest rate. To qualify for the lowest rate, you must have a responsible financial history and meet other conditions. If approved, your actual rate will be within the range of rates listed above and will depend on a variety of factors, including term of loan, a responsible financial history, years of experience, income and other factors. Rates and Terms are subject to change at anytime without notice and are subject to state restrictions. SoFi refinance loans are private loans and do not have the same repayment options that the federal loan program offers such as Income Based Repayment or Income Contingent Repayment or PAYE. Licensed by the Department of Business Oversight under the California Financing Law License No. 6054612. SoFi loans are originated by SoFi Lending Corp., NMLS # 1121636. (www.nmlsconsumeraccess.org)

3 Important Disclosures for CommonBond.

CommonBond Disclosures

  1. Offered terms are subject to change. Loans are offered by CommonBond Lending, LLC (NMLS # 1175900). The following table displays the estimated monthly payment, total interest, and Annual Percentage Rates (APR) for a $10,000 loan. The Annual Percentage Rate (APR) shown for each in-school loan product reflects the accruing interest, the effect of one-time capitalization of interest at the end of a deferment period, a 2% origination fee, and the applicable Repayment Plan. All loans are eligible for a 0.25% reduction in interest rate by agreeing to automatic payment withdrawals once in repayment, which is reflected in the interest rates and APRs displayed. Variable rates may increase after consummation. All variable rates are based on a 1-month LIBOR assumption of 2.08% effective July 25, 2018.

4 Important Disclosures for Citizens Bank.

Citizens Bank Disclosures

  1. Education Refinance Loan Rate DisclosureVariable rate, based on the one-month London Interbank Offered Rate (“LIBOR”) published in The Wall Street Journal on the twenty-fifth day, or the next business day, of the preceding calendar month. As of August 1, 2018, the one-month LIBOR rate is 2.07%. Variable interest rates range from 2.72%-8.17% (2.72%-8.17% APR) and will fluctuate over the term of the borrower’s loan with changes in the LIBOR rate, and will vary based on applicable terms, level of degree earned and presence of a cosigner. Fixed interest rates range from 3.50%-8.69% (3.50% – 8.69% APR) based on applicable terms, level of degree earned and presence of a cosigner. Lowest rates shown require application with a cosigner, are for eligible, creditworthy applicants with a graduate level degree, require a 5-year repayment term and include our Loyalty discount and Automatic Payment discounts of 0.25 percentage points each, as outlined in the Loyalty and Automatic Payment Discount disclosures. The maximum variable rate on the Education Refinance Loan is the greater of 21.00% or Prime Rate plus 9.00%. Subject to additional terms and conditions, and rates are subject to change at any time without notice. Such changes will only apply to applications taken after the effective date of change. Please note: Due to federal regulations, Citizens Bank is required to provide every potential borrower with disclosure information before they apply for a private student loan. The borrower will be presented with an Application Disclosure and an Approval Disclosure within the application process before they accept the terms and conditions of their loan.
  2. Federal Loan vs. Private Loan Benefits: Some federal student loans include unique benefits that the borrower may not receive with a private student loan, some of which we do not offer with the Education Refinance Loan. Borrowers should carefully review their current benefits, especially if they work in public service, are in the military, are currently on or considering income based repayment options or are concerned about a steady source of future income and would want to lower their payments at some time in the future. When the borrower refinances, they waive any current and potential future benefits of their federal loans and replace those with the benefits of the Education Refinance Loan. For more information about federal student loan benefits and federal loan consolidation, visit http://studentaid.ed.gov/. We also have several resources available to help the borrower make a decision at http://www.citizensbank.com/EdRefinance, including Should I Refinance My Student Loans? and our FAQs. Should I Refinance My Student Loans? includes a comparison of federal and private student loan benefits that we encourage the borrower to review.
  3. Citizens Bank Education Refinance Loan Eligibility: Eligible applicants may not be currently enrolled, must be in repayment of their existing student loan(s) and must make the minimum number of payments after leaving school. Primary borrowers must be a U.S. citizen, permanent resident or resident alien with a valid U.S. Social Security Number residing in the United States. Resident aliens must apply with a co-signer who is a U.S. citizen or permanent resident. The co-signer (if applicable) must be a U.S. citizen or permanent resident with a valid U.S. Social Security Number residing in the United States. For applicants who have not attained the age of majority in their state of residence, a co-signer will be required. Citizens Bank reserves the right to modify eligibility criteria at anytime. Interest rate ranges subject to change. Education Refinance Loans are subject to credit qualification, completion of a loan application/consumer credit agreement, verification of application information, certification of borrower’s student loan amount(s) and highest degree earned.
  4. Loyalty Discount Disclosure: The borrower will be eligible for a 0.25 percentage point interest rate reduction on their loan if the borrower or their co-signer (if applicable) has a qualifying account in existence with us at the time the borrower and their co-signer (if applicable) have submitted a completed application authorizing us to review their credit request for the loan. The following are qualifying accounts: any checking account, savings account, money market account, certificate of deposit, automobile loan, home equity loan, home equity line of credit, mortgage, credit card account, or other student loans owned by Citizens Bank, N.A. Please note, our checking and savings account options are only available in the following states: CT, DE, MA, MI, NH, NJ, NY, OH, PA, RI, and VT and some products may have an associated cost. This discount will be reflected in the interest rate disclosed in the Loan Approval Disclosure that will be provided to the borrower once the loan is approved. Limit of one Loyalty Discount per loan and discount will not be applied to prior loans. The Loyalty Discount will remain in effect for the life of the loan.
  5. Automatic Payment Discount Disclosure: Borrowers will be eligible to receive a 0.25 percentage point interest rate reduction on their student loans owned by Citizens Bank, N.A. during such time as payments are required to be made and our loan servicer is authorized to automatically deduct payments each month from any bank account the borrower designates. Discount is not available when payments are not due, such as during forbearance. If our loan servicer is unable to successfully withdraw the automatic deductions from the designated account three or more times within any 12-month period, the borrower will no longer be eligible for this discount.
  6. Co-signer Release: Borrowers may apply for co-signer release after making 36 consecutive on-time payments of principal and interest. For the purpose of the application for co-signer release, on-time payments are defined as payments received within 15 days of the due date. Interest only payments do not qualify. The borrower must meet certain credit and eligibility guidelines when applying for the co-signer release. Borrowers must complete an application for release and provide income verification documents as part of the review. Borrowers who use deferment or forbearance will need to make 36 consecutive on-time payments after reentering repayment to qualify for release. The borrower applying for co-signer release must be a U.S. citizen or permanent resident. If an application for co-signer release is denied, the borrower may not reapply for co-signer release until at least one year from the date the application for co-signer release was received. Terms and conditions apply.
  7. Average savings based on 18,113 actual customers who refinanced their federal and private student loans through our Education Refinance Loan between January 1, 2017 and December 31, 2017. The calculation is derived by averaging the monthly savings of Education Refinance Loan customers whose payments decreased after refinancing, which is calculated by taking the monthly student loan payments prior to refinancing minus the monthly student loan payments after refinancing. The borrower’s savings might vary based on the interest rates, balances and remaining repayment term of the loans they are seeking to refinance. The borrower’s overall repayment amount may be higher than the loans they are refinancing even if their monthly payments are lower.
2.57% – 5.87%Undergrad
& Graduate
Visit Earnest
2.80% – 6.38%1Undergrad
& Graduate
Visit Laurel Road
2.48% – 7.52%2Undergrad
& Graduate
Visit SoFi
2.47% – 7.99%Undergrad
& Graduate
Visit Lendkey
2.57% – 6.65%3Undergrad
& Graduate
Visit CommonBond
2.72% – 8.17%4Undergrad
& Graduate
Visit Citizens
Our team at Student Loan Hero works hard to find and recommend products and services that we believe are of high quality and will make a positive impact in your life. We sometimes earn a sales commission or advertising fee when recommending various products and services to you. Similar to when you are being sold any product or service, be sure to read the fine print understand what you are buying, and consult a licensed professional if you have any concerns. Student Loan Hero is not a lender or investment advisor. We are not involved in the loan approval or investment process, nor do we make credit or investment related decisions. The rates and terms listed on our website are estimates and are subject to change at any time. Please do your homework and let us know if you have any questions or concerns.