When you choose what to wear or what to have for breakfast, or which way to drive to work, you’re confident. These seem like simple choices, and you can make them easily based on the information available to you. (Out of bread and milk? Eggs it is! Highway construction? Back roads for you!)

But between the ACA regulations and the seemingly endless paperwork, choosing health insurance can feel much more complicated than that. There’s extra confusion about group health insurance. If your company offers insurance, do you have to take it, or do you still have individual options available to you?

We’re here to answer those questions. Following a few simple steps can make the health insurance decision easier. When you call HealthMarkets Insurance Agency, we’ll walk you through this process, and show you how to choose a health insurance plan that really fits.

Choosing Health Insurance in 4 Steps

Step 1: Decide whether to take your employer-sponsored group health insurance.

If you’re employed, chances are your employer offers a group plan. You probably want to take advantage of it. If you don’t, you can sign up for an individual plan, but you won’t be eligible for federal subsidies which can lower your costs. (Don’t know about those? See Step 2!)

If you work for a small business that doesn’t offer health insurance or your employer’s plan is too expensive or doesn’t cover family members, you may have options. Talk to a licensed agent with HealthMarkets who can walk you through the next few steps! They are also available to consult with your company to help them discover little-known solutions to help them provide personalized, individual plans for each employee that fits their unique needs and budget.

Step 2: Find out whether you qualify for federal subsidies.

Subsidies are government assistance for your health insurance. They come in the form of premium tax credits that reimburse you for your premiums OR cost-sharing assistance on your out-of-pocket expenses. Whether or not you get subsidies depends on your household size, your income, and the Federal Poverty Level—the yearly income at which the government considers a household in poverty. If you’re of low or moderate income, you may qualify for subsidies.

If that all seems a little complicated, don’t worry. A HealthMarkets agent can help you find out if you are eligible for subsidies.

Now it’s time to do a little more research in Step 3!

Step 3: Determine which subsidies apply to you.

Here’s how you determine your subsidy status.

Approximate Household Subsidy Eligibility in 2015*

Household Size Federal Poverty Level Premium Tax Credits Out-of-Pocket Assistance
1 $11,770 up to $47,080 up to $29,425
2 $15,930 up to $63,720 up to $63,720
3 $20,090 up to $80,360 up to $50,225
4 $24,250 up to $97,000 up to $60,625

*These numbers are approximate. Hawaii and Alaska use different guidelines. For more information on whether you qualify for subsidies, contact HealthMarkets. Source: https://obamacarefacts.com/federal-poverty-level/

Cost-Sharing Subsidies: If you make between 100% – 250% of the Federal Poverty Level you may qualify for out-of-pocket cost assistance called cost-sharing subsidies to help you with health costs. An agent can help you find out if you are eligible for this subsidy and help you apply for a plan using it.

If you’re eligible for these subsidies, you’ve reached your final step: choosing your Silver plan. Why a Silver plan? Because out-of-pocket assistance is only available with Silver plans! There are lots of options for Silver plans, and an agent can help you determine which is right for you and your family. (Don’t know what those are? See Step 4!)

Premium Tax Credits: If you make between 100%–400% of the Federal Poverty Level you may qualify for premium tax credits to reimburse you for the price of your insurance. Premium tax credits can be applied to any Marketplace plan, and an agent can help you determine if you are eligible for a premium tax credit.

It’s time to move on to Step 4: shopping!

Step 4: Finally … choose your plan!

Now you’re ready to start shopping for individual plans. These plans fall into four “metal-level” categories: Bronze, Silver, Gold and Platinum. If you are under 30 years old or qualify for a “hardship exemption”—an exemption based on a life situation that prevents you from getting health insurance—you also have the option of a Catastrophic Coverage plan, which has very low monthly premiums but very high deductibles.

When you’re deciding between plans, look at your budget and your health needs. Do you have a limited monthly budget? You may need to choose a Bronze or Silver level plan. Do you go to the doctor a lot or take medications? You may need to choose a Gold or Platinum level plan.

Why? It all has to do with your premiums and your out-of-pocket expenses. Metal-level plans with lower premiums have higher out-of-pocket expenses (the money you pay at the time of your health services). Plans with higher premiums, on the other hand, have low out-of-pocket expenses. Once you choose a metal level, you can focus only on the plans in that category to help narrow your search.

Have questions? Check out our infographic for more information! Or, if you’d like a hand in the enrollment process, call HealthMarkets at (800) 304-3414. We’ll talk you through each of these steps and find the right plan for you.


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