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How do you know when a health plan is right for you?

Start with what matters most to you: the doctors you want to see, the prescriptions you take, what you may pay, and the care you may need throughout the year. We’ll walk you through the key things to consider as you explore your options and choose a plan.

What to look for when comparing health plans

We know choosing a health plan can feel overwhelming. Doctors and hospitals, prescription coverage, and what you pay can vary by plan. Financial help, if you qualify, can also affect what you pay. As you compare your options, consider the care you and your family may need, the prescriptions you take, and your budget.

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Care options

  • Will you have access to the doctors and hospitals you prefer?
  • Will you need a referral to see a specialist?
  • Are online doctor visits available?
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Prescriptions

  • Are your prescriptions included?
  • Can you use your preferred pharmacy?
  • What will you pay for your medications?
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Receiving care

  • How often do you expect to visit a doctor or specialist?
  • Are routine checkups and preventive care included?
  • Are digital tools available to help you manage your care?

Consider the full cost and value of each plan

What you pay each month is only part of the picture

As you compare plans, consider what each would cost after any financial help you qualify for is applied. In addition to the premium, look at the deductible, copays, prescription costs, coinsurance, and the out-of-pocket maximum based on how often you expect to use care.

Also see how the plan supports your whole health. Access to nearby care, and resources for physical, emotional, and everyday needs can make it easier to get the right support and make the most of your health plan.

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Understanding how health plan costs may vary

Health plans balance what you pay each month with how costs are shared between you and your health plan when you receive covered care. These examples show two common ways those costs can shift.

Lower monthly payments and higher costs when you receive care

  • Monthly premium payment Lower
  • Deductible Higher
  • Out-of-pocket care costs Higher

Higher monthly payments and lower costs when you receive care

  • Monthly premium payment Higher
  • Deductible Lower
  • Out-of-pocket care costs Lower

Not sure what these terms mean? See the Health Insurance Glossary.

Frequently Asked Questions

In addition to your monthly premium payment, consider the total cost of coverage — including the plan deductible, copays, coinsurance, prescription costs, and annual out-of-pocket maximum — to find a plan that fits your budget. Think about the care you expect to need in the coming year, such as doctor visits and prescriptions, as well as how the plan supports your overall health. Features like convenient online doctor visits, preventive care, digital tools, and well-being programs can also make it easier to access care and get the most from your plan.

For Anthem coverage, visit anthem.com/find-care to search for doctors, hospitals, and other care options. You can also review the medication list to see whether your prescriptions are covered, where you can fill them, and what you may pay.

Not necessarily. Consider both your monthly premium payment and what you may pay when you receive care or fill prescriptions. If you qualify for financial help, you may also be able to lower your monthly premium and, in some cases, your out-of-pocket costs.

A higher-deductible plan may have a lower monthly premium payment, but you may pay more out-of-pocket when you need care. A lower-deductible plan may have a higher monthly premium payment, but you may pay less out-of-pocket when receiving covered healthcare services.

A plan with a lower monthly premium payment may fit someone who wants to spend less each month and can manage potentially higher costs when they need care. A plan with a higher monthly premium payment may make sense if it offers lower costs for the care and prescriptions you expect to use. The right fit depends on your healthcare needs, expected use of care and prescriptions, budget, and comfort with out-of-pocket costs as they arise.

Affordable Care Act (ACA) Marketplace plans are grouped into Bronze, Silver, Gold, and Platinum metal levels. These categories reflect how you and your insurer generally share the cost of covered care — not the quality of care you receive. Bronze plans generally have a lower monthly premium payment and higher costs when you receive care, while Gold and Platinum plans generally have a higher premium payment and lower costs for care. Silver plans generally fall in between and are also the only metal level that offers cost-sharing reductions for those who qualify, which can further lower out-of-pocket costs for care. Keep in mind that not every insurer offers plans at every metal level in every area.

Depending on your household income and size, you may qualify for financial help that lowers your monthly premium payment. You may also qualify for additional savings that lower what you pay out-of-pocket for care, including your deductible, copays, and coinsurance. These additional savings are only available when you enroll in a Silver Marketplace plan.

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