Time’s Running Out: Pick an ‘Obamacare’ Plan by Jan. 31

Finding Health Insurance, Health
Pick a Health Care Plan By Jan. 31

If you haven’t yet enrolled in an individual health insurance plan through former President Barack Obama’s health care law, act fast: The deadline to sign up is Jan. 31.

The Affordable Care Act might be repealed or changed in coming months, but right now, federal law says that you must have health insurance or you’ll pay a tax penalty. If you qualify for tax subsidies, shopping on the federal or a state exchange is the only way to receive them. Exchange plans can be found:

  • At Healthcare.gov or your state’s exchange website.
  • Through health insurance comparison sites.
  • Through a health insurance broker.

If getting a subsidy isn’t a concern, you can also shop for plans directly through health insurers.

» MORE: Obamacare subsidies

Here’s how to make a quick decision before the open enrollment window closes.

Look closely at costs

Many people choose a plan based on the monthly premium. That’s an important factor, but there are other out-of-pocket costs to consider:

  • Deductibles: The amount you pay upfront for medical care each year before your plan pays. Some plans cover certain services, such as primary physician visits, before you meet the deductible; others don’t.
  • Copayments: A flat fee you pay at the time of a medical service, such as $25 for a doctor visit or $10 for a prescription.
  • Coinsurance: A portion of the cost of a medical service, which you typically pay even after you’ve met your deductible, such as 20% of the cost of an X-ray or 30% of a laboratory fee for bloodwork.
  • Out-of-pocket spending limits: The most you’ll pay each year for copays, coinsurance and deductibles before the plan pays 100% of your medical bills.

The health plan with the lowest monthly premium likely has some of the highest out-of-pocket costs. In other words, if your family frequently uses medical services, you have a surgery coming up, or you plan to become pregnant, “maybe a plan with a higher premium and lower deductible is a better choice,” says Ellen FitzPatrick, vice president of partnership development at Copatient, a medical cost consulting firm.

Pick a tier, then compare choices

Plans on the exchanges are grouped into “metal tiers” based on the average amount they pay for care:

  • Bronze: Plans pay 60% of charges.
  • Silver: Plans pay 70% of charges.
  • Gold: Plans pay 80% of charges.
  • Platinum: Plans pay 90% of charges.

Bronze plans generally have the lowest premiums and the highest deductibles, copays and coinsurance. Use the metal tier system to compare costs of the available plans and pick a few to look at more carefully.

» MORE: Choosing the right health insurance plan “metal tier”

Examine the provider network and benefits you want

Before you choose any plan, “know what’s covered — and what’s not,” FitzPatrick says. Make sure the plan you select pays for your doctor visits, as well as services and medications you regularly use.

  • If you have one or more doctors you want to keep, check that they’re listed in your plan’s provider directory before you buy. You’ll often find a link to the directory near the plan’s details on comparison sites and on the insurer’s website.
  • If you use specific health services due to a chronic condition, such as diabetes, make sure they’re covered services in the plan’s summary of benefits.
  • If you take medications, look them up in your plan’s formulary and find out how much you’ll pay. Search for the generic names, not the brand names. For example, if you take Synthroid for a thyroid disorder, search for the active ingredient “levothyroxine” instead.

» COMPARE: Health insurance quotes

If you’re unsure whether the insurers you’re considering will pay for your drug or doctor visits, call sooner than later. Customer service phone wait times will likely increase as the Jan. 31 deadline gets closer.

Even if you don’t have questions, avoid signing up on the last day in case of any last-minute website glitches due to high demand.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: lacie@nerdwallet.com. Twitter: @LacieWrites.