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Choosing a health insurance plan 101

Shopping for insurance through your state marketplace? These four questions will help you pick a plan.

By Lauren Birchfield Kennedy of the National Partnership for Women & Families.

The Affordable Care Act’s open enrollment period is in full swing. In fact, you only have until March 31, 2014 to get coverage through your state marketplace—so if you haven’t signed up already, there’s no time like the present!

To get coverage, all you have to do is visit HealthCare.gov and fill out an application. (By sharing basic demographic and income information, you can also find out if you’re eligible for financial help to make your plan more affordable.) The next step is to choose a health plan based on your budget and your individual health needs.

The following four questions can help you decide which health plan is the best choice for you and your family:

1. How much health care do I need?

The health plan that’s best for you depends on how much health care you need and on the type of health services you’re likely to access.

  • Do you expect to visit a doctor often? You may want to consider a gold or platinum plan, which require a higher monthly premium payment and cover a larger percentage of your health care costs, leaving you with fewer out-of-pocket expenses.

  • Do you only go to the doctor once a year? A lower-premium bronze or silver plan may be a better fit.

Remember: Regardless of which level plan you choose, your birth control and other key preventive services should be covered without additional out-of-pocket costs.

2. Is my preferred brand of birth control covered?

While health plans are required to cover all FDA-approved methods of contraception without any cost-sharing, not every plan covers all brands of contraceptives. For example, there are dozens of brands of birth control pills, including generic versions of name brands. If you strongly prefer a specific brand of birth control, you should check to see if that brand is covered by the plan you are considering.

3. How important is it to me to stick with my current doctor?

Ask yourself how important it is to you to keep your current health care provider. Are you willing to look for a new one? If not, you may want to make sure that your provider is “in-network.” (If you visit a provider who is “out-of-network,” you might have to pay more.)

Health plans offered in the marketplace are responsible for providing a list of participating in-network providers. If you can’t find the list online, call the HealthCare.gov call center at 1-800-318-2596 or the insurance company for help.

4. Am I expecting any major life events in the coming year?

Life-changing events may cause you to need more health care than you usually do. For example, if you’re planning on having a baby, you may want to choose a more robust health plan that will cover a greater portion of the out-of-pocket costs for maternity care.

The Affordable Care Act requires all health plans to cover maternity services as an essential health benefit. However, exactly which maternity care services are covered by plans will vary from state to state. Make sure to ask a representative from a health plan to verify exactly what types of services are covered under its maternity care benefit. The cost of pregnancy and labor and delivery can be very high if you have to pay for it out-of-pocket, so you’ll want to know what a plan covers before you purchase it.

Even if you don’t need maternity care now, you might in the future. And of course, if you’re not planning to get pregnant, make sure your birth control is covered.

Once you’ve answered these important questions, you should be set to choose the plan that’s right for you.

And remember: sign up for coverage by March 31, 2014!


Lauren Birchfield Kennedy is the senior health policy counsel at the National Partnership for Women & Families. Kennedy advises the National Partnership’s health policy agenda and oversees advocacy strategy for key policy priorities, including Affordable Care Act implementation and insurance market reform. She has an extensive background in women’s health policy and expertise in health programs serving lower income women, including Medicaid and the Title X family-planning program. Kennedy holds a law degree from Harvard Law School and a B.A. from UCLA. She splits time between D.C. and Massachusetts, all the while dreaming of her native California.

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