In most states, open enrollment for the Affordable Care Act (ACA) marketplace ends on January 15. If you’re purchasing a plan on your own, now is the ideal time to purchase and modify health insurance. But which health insurer is the best?
To determine which large insurance providers in the nation provide the best health insurance, we examined their ACA plans. In terms of ACA plan coverage, Kaiser Permanente and Blue Cross Blue Shield come in first place on our list. However, don’t forget to look into regional and smaller providers on the ACA marketplace. Options differ depending on the state.
The Best Health Insurance Companies
- Kaiser Permanente – Best Overall
- Blue Cross Blue Shield – Best Provider Network
- UnitedHealthcare – Best for Low Out-of-Pocket Costs
What Is Health Insurance?
Healthcare costs can be covered by health insurance, provided that the procedure or medication is covered by the policy. Your health insurer covers the majority of your medical expenses after you pay a premium for the coverage.
The medical specialists that accept the health plan are known as provider networks, and they are typically a feature of health insurance plans. While some health plans might permit you to receive care outside of the network, others might require you to remain within the provider network in order for the plan to pay for services. Plans that permit out-of-network medical care typically charge more for that care than they do for in-network care.
The majority of Americans in their pre-retirement years obtain health insurance via their employers, but you can also purchase a plan directly from an insurance provider or through the ACA marketplace.
Health Insurance Coverage
All of the health insurance plans available on the federal marketplace comply with the Affordable Care Act, which means they offer coverage for ten different service categories. These must be provided as essential health benefits:
- ambulatory care
- Services for emergencies
- hospitalization for procedures, surgeries, or stays longer than one night
- Pregnancy, maternity, and postpartum care of the newborn
- Services for substance abuse disorders and mental health
- prescription medications
- Services and equipment for rehabilitation and habilitation for people with chronic illnesses, injuries, or disabilities
- services for laboratories
- Wellness and preventive services, such as HIV testing and counseling and cervical cancer screening
- pediatric services, such as dental and vision care
Birth control and breastfeeding services are also required to be covered by ACA marketplace plans, commonly known as Obamacare.
It’s crucial to read the fine print because a plan’s coverage will differ beyond these basic benefits. For instance, insurance companies might provide medical management programs and dental and/or vision care for certain health issues like back pain and diabetes.
Bronze, Silver, Gold And Platinum Health Insurance Plans
“Metal tiers” on the ACA marketplace let you compare the costs of various health plans. The premiums and cost-sharing of a plan, or the amount you will have to pay out of pocket, determine the metal tiers.
Bronze, silver, gold, and platinum are the metal tiers of the health plan. A bronze or silver plan may be more advantageous for those who don’t anticipate using many healthcare services in the course of a year. However, if you visit the doctor frequently and utilize a variety of healthcare services, a gold or platinum plan might be a better option.
How Much Does Health Insurance Cost?
For a 30-year-old, a silver plan typically costs $488 per month.
- A forty-year-old makes $549 a month on average.
- A fifty-year-old makes $767 on average per month.
- An average monthly payment for a 60-year-old is $1,164.
The cost of Obamacare health insurance varies depending on several factors, such as age and metal tier. Compared to Gold plans, Bronze and Silver plans have higher out-of-pocket expenses but lower premiums.
What Does Health Insurance Cover?
Typically, health insurance pays for:
- Doctor visits
- Hospital visits
- Outpatient care
- Preventive coverage, such as annual physicals
- Prescription drugs
- Labs and tests
Lack of health insurance can have an impact on your capacity to pay for care as well as your ability to receive it. Lack of health insurance can exacerbate medical issues because uninsured individuals frequently put off or never seek medical attention.
What Does Health Insurance Not Cover?
Depending on the health insurance provider and plan type, certain services may not be covered by insurance, or may be covered only in part.
For instance:
- Care received outside of your provider network is not covered by an exclusive provider organization (EPO) or health maintenance organization (HMO) plan.
- Out-of-network care will be reimbursed by a preferred provider organization (PPO), but at a reduced rate compared to in-network care. This implies that a larger portion of the out-of-network care expenses will fall on you as a member.
Here are examples of what a health insurance plan may not cover:
- Out-of-network care
- Cosmetic surgery
- Some prescription drugs
- Fertility care
- Experimental treatments and drugs
Ways to Get Health Insurance
Employers provide health insurance to the majority of Americans who are not yet retired. If you’re under 26, your parents’, spouse’s, or employer’s health plan may be able to provide you with coverage.
From an Employer
Most Americans who are not yet retirement age obtain their health insurance through their employers through group health insurance. Health insurance is frequently provided by employers as one of their benefits.
Since employers usually cover more than half of the costs, group coverage is typically more affordable than purchasing health insurance in other ways.
Affordable Care Act Health Insurance Marketplace
Those who are not eligible for an employer-sponsored health plan can purchase health insurance through the ACA health insurance marketplace at Healthcare.gov. While some states have opted to run their own exchanges on separate websites, Healthcare.gov allows you to locate the appropriate exchange for your state.
You can evaluate the plans that are offered in your area by using the federal marketplace and state exchanges. You can input details about your family and income. The marketplace website calculates your cost estimates for each plan, taking into account premium tax credits and subsidies that lower the cost of ACA plans. It does this by using your income.
Directly from a Health Insurance Company
A single health insurance plan can be purchased from an insurer directly, bypassing the federal marketplace website. These plans might be identical to those available through the ACA exchange. You will not be eligible for the subsidies offered by ACA plans if you choose this course.
Additionally, health insurance providers may offer non-ACA exchange and non-federally compliant plans for sale. Although purchasing a plan directly from an insurer may result in a lower cost, the plans offered on the federal health insurance marketplace may offer greater coverage.
Medicare
Medicare is a federal health insurance program for the elderly, certain disabled individuals, and those suffering from end-stage renal disease.
Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare Part D are among the components of Medicare.
- Hospital stays, skilled nursing facilities, and hospice care are all covered in Part A.
- Medical supplies, preventive services, outpatient care, and physician services are all covered in Part B.
Prescription drug benefits are available to members who purchase a Part D plan in addition to their Parts A and B plans.
Medicare’s gaps will be partially filled by Medigap plans.
Medicare Advantage is an additional option provided by commercial health insurance providers. Members of Medicare Advantage are eligible for prescription drug benefits in addition to the Parts A and B benefits. Medicare Advantage plans frequently provide extra benefits like dental and vision care, as well as help with transportation and meal costs.
Methodology
To identify the top health insurance providers, we examined 84 data points regarding coverage and quality for seven sizable health insurance providers. We base our ratings on:
- 30% of the score was derived from complaints filed with state insurance departments. The National Association of Insurance Commissioners provided the complaint data.
- The National Committee for Quality Assurance’s plan ratings account for 30% of the total score. An independent nonprofit organization called the National Committee for Quality Assurance (NCQA) accredits health plans and assigns ratings based on a number of criteria, such as patient experience, treatment, prevention, overall health plan rating, and care rating.
- Average silver plan deductible (20% of score): The deductible is the annual amount of medical expenses you must pay out of pocket before your health plan starts to reimburse some of the costs. Businesses with low-deductible health plans received additional points.
- Health insurance providers may provide up to four different plan benefit designs (PPO, HMO, EPO, and POS). This accounts for 10% of the total score. Businesses with a wider range of plan options received higher marks.
- Offerings for metal tiers (10% of score): There are four metal tier levels in the ACA marketplace. Businesses that provided more options for tier plans received points from us.