How to choose Marketplace insurance Type of plan and provider network

There are different types of health insurance plans that meet different needs. Some examples include HMO, EPO, PPO, and POS plans.

Different plan types provide different levels of coverage for care you get inside and outside of the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. There are other differences between plan types too.

When comparing your options in the Marketplace, you’ll see health plan details. Make sure to note the type of each plan you’re considering.

To get details about the plan you can also view a summary of benefits, a plan brochure, a provider directory, and a list of covered drugs. If staying with your current doctors is important to you, check to see if they're included in the provider directory before choosing a plan.

You can find quality information about doctors, hospitals, and other care providers by using our quality compare tools.

Monthly premiums are important, but they’re not all you need to think about. Picking a plan only because its premium is low may not be the best decision for you.

• If your plan has a lower monthly premium, your out-of-pocket costs may be higher when you need care.
• If your plan has a higher premium, your out-of-pocket costs may be lower when you need care.

Generally speaking, the lower your monthly premium the higher your out-of-pocket costs will be. It’s important to keep this in mind when you compare plans.

It’s important to know how much you have to pay out of your pocket for services when you get care. You pay these out-of-pocket costs in addition to your monthly premiums.

The category of plan you choose affects how much you spend on out-of-pocket costs. Generally, Bronze and Silver plans have lower monthly premiums, but you’ll pay higher out-of-pocket costs when you need care. Gold and Platinum plans generally have higher premiums but lower out-of-pocket costs.

The maximum out-of-pocket costs for any Marketplace plan for 2015 are $6,600 for an individual plan and $13,200 for a family plan. This means when the amount you’ve paid in deductibles, copayments, and coinsurance reaches these limits, the insurance company pays 100% of your costs for covered care. Even if you choose a catastrophic coverage planyour out-of-pocket costs shouldn’t exceed this limit.

Savings on out-of-pocket costs with a Silver plan

If you qualify for lower out-of-pocket costs based on your household size and income and choose a Silver plan, you can save more. This called a “cost-saving reduction.”

With a cost-sharing reduction, you’ll pay lower deductibles, copayments, and coinsurance. You'll basically get the lower out-of-pocket costs of a Gold or Platinum plan while paying a Silver plan premium. You can choose any category of plan, but you get these savings on out-of-pocket costs only if you enroll in a Silver plan.