Your Guide to Smarter Insurance Decisions
Build a practical understanding of coverage, costs, networks, and plan types before you compare your options.
- Plain-language definitions
- Plan comparison basics
- Questions to ask
Understand the Costs You May Share
The lowest monthly premium is not always the lowest total cost. Review how the plan handles routine care and larger medical events.
Premium
The amount you pay to keep an insurance policy active, usually billed monthly.
Deductible
The amount you pay for covered services before the plan begins sharing certain costs.
Copay and Coinsurance
A fixed fee or percentage that represents your share of a covered service.
Out-of-Pocket Maximum
The most you pay in a plan year for covered, in-network services before the plan pays the covered balance.
What ACA Marketplace Plans Generally Include
Marketplace plans generally cover 10 categories of essential health benefits. Exact services, limits, and networks vary by plan.
- Outpatient care
- Emergency services
- Hospitalization
- Prescription drugs
- Preventive care
- Mental health services
- Maternity and newborn care
- Pediatric services
- Rehabilitative services
- Laboratory services
Know How Provider Access Works
Compare each plan’s actual network, referral rules, benefits, and exclusions. The acronym alone does not tell the whole story.
- HMO
Health Maintenance Organization
Uses a defined network and may require a primary care provider and referrals for specialist care.
- PPO
Preferred Provider Organization
Usually offers greater provider flexibility and may include out-of-network benefits at a higher cost.
- EPO
Exclusive Provider Organization
Typically covers in-network care without requiring referrals, except for emergencies.
- HDHP
High-Deductible Health Plan
Pairs lower premiums with a higher deductible and may be eligible for use with a Health Savings Account.
Bring These Questions to the Comparison
- Are my doctors, hospitals, and pharmacies in network?
- How are my regular prescriptions covered?
- What applies before and after the deductible?
- Do I need referrals or prior authorization?
- What services and situations are excluded?
- What is the annual out-of-pocket maximum?
Not Sure Which Plan Is Right for You?
Tell us how you use care and what needs to fit your budget. A licensed agent will help you compare available options.