How to choose Marketplace insurance

Out-of-pocket costs

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 plan your 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 is called a “cost-sharing 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.

If you make $11,670 to $29,175 for individuals or $23,850 to $59,625 for a family of 4, you may be eligible for a cost-sharing reduction. The lower your income within these ranges, the more you’ll save on out-of-pocket costs.

Get more information about cost-sharing reductions for American Indians and Alaska Natives.