But with multiple plans available, how do you know which one is right for you? The good news is that understanding a few key concepts can make it easier to compare options and choose confidently.

Key Takeaways

• All Marketplace plans include essential benefits like doctor visits, prescriptions, mental health care and preventive services.
• Most people qualify for savings that lower monthly premiums or reduce out-of-pocket costs.
• Plans cover pre-existing conditions and offer free preventive care.
• To find the best plan for your needs and budget, consider your doctors, medications, expected healthcare use and overall costs.

How to Get Started Shopping for Marketplace Health Insurance

Shopping for a Marketplace plan is easier than you might think. You can visit Healthcare.gov or go directly to a trusted provider’s site—like Ambetter Health—to explore plans in your area.

Once there, a guided shopping tool will walk you through the process step by step. It’s a good idea to check if you qualify for savings, even if you think you don’t.

To find the best match, you’ll be asked questions like:

• How often do you expect to visit a doctor or need prescriptions
• Do you have preferred doctors, hospitals or clinics you want to keep?
• Are there specific medications you use regularly?

Based on your answer, the system will show plans that meet your needs and budget. And don’t worry, you’ll only see plans available in your area, so you won't waste time comparing options that aren’t a good fit.

Metal Levels Matter

Marketplace plans are grouped into four “metal” categories: Bronze, Silver, Gold and Platinum. Those don’t affect the quality of care, but they do determine how costs are shared between you and the insurance company.

All four levels qualify for premium tax credits based on your income. However, only Silver plans are eligible for additional cost-saving discounts known as cost-sharing reductions. If you qualify, cost-sharing reductions can lower your deductible, copays and out-of-pocket maximum, making Silver a strong value for many individuals and families.

Compare Total Costs

When comparing health insurance plans, it’s important to look beyond just the monthly premium. Make sure you understand your total costs throughout the year.

Total costs include:

• Monthly premium: This is the amount you pay every month to keep your insurance active, whether or not you use medical services.
• Out-of-pocket costs:
  • Deductible: the amount you pay out of pocket before your insurance begins to cover most services.
  • Copays and coinsurance: these are your share of costs when you visit a doctor, fill a prescription or get other types of care.
• Out-of-pocket maximum (OOP max): This is the most you’ll pay in a year for covered, in-network care. After you hit this limit, your insurance covers 100% of your eligible costs for the rest of the year.

Tip: If you have a health condition or expect to visit providers and get prescription medications often, a plan with a higher premium but lower out-of-pocket costs may help you save money in the long run.

Check the Network of Providers

Many health plans do not cover care from out-of-network doctors or hospitals. That means you could have to pay the full cost.

If you entered your preferred doctors during the shopping process, you can filter plans to show only those that include them.

If you skipped that step, don't worry. You can still view the provider list in the "plan-details" section of each plan. Make sure your current doctors, clinics or hospitals are in-network before you enroll.

Review Prescription Drug Coverage

If you take any regular medications, make sure they’re covered:

• During shopping: Enter your prescriptions when prompted. You’ll be able to filter plans based on drug coverage.
• After shopping: If you skipped that step, look in the plan details for a drug list (also called a formulary). Check to see:
  • If your medications are covered
  • What you’ll pay for each one

This helps you avoid surprise costs and choose a plan that fits your needs.

Filter and Compare Plans

Once you’ve entered your preferred doctors and prescriptions, use the filters to narrow your results:

• Filter by providers and medications to see plans that include your current care team and prescriptions.
• If you qualify for cost-sharing reductions, filter for Silver-level plans; those are the only ones that include extra savings on out-of-pocket costs.

Next, compare your options:

• Select a few plans to view side by side. You'll see a comparison of monthly costs, deductibles, copays and benefits.
• Check each plan’s “Summary of Benefits and Coverage” for more details.
  • Look at the “What You Will Pay” columns to understand costs for common services.
  • If your preferred providers aren’t in-network, check the out-of-network column to see what you’d pay.

This step can help you confidently choose a plan that fits both your needs and your budget.

Get Additional Help if Needed

If you have questions while shopping for a plan, support is available:

• Visit Healthcare.gov’s help center to get answers, chat online or find in-person assistance.
• Call the insurance companies you’re considering. Licensed agents can help you compare plans, answer your questions and guide you toward the best option for your needs.
  

Questions About Choosing the Right ACA Marketplace Insurance Plan