How to Pick the BEST Marketplace Plan 2025

May 7, 2025

205 18 minutes read

How to Pick the BEST Marketplace Plan 2025

Almost 2025 I know I can’t believe it either and you know what that means it’s time to talk about health insurance of your different options for 20125 first I want to focus on costs because of course when you’re comparing different plans you want to make sure you’re getting the best bang for your buck so let’s talk about the different costs that you need to consider some of which you may already be thinking about and some of which may not be as obvious let’s start with your monthly premiums so your monthly premium is of course the amount that you pay out of pocket to keep your insurance active now if we’re talking about a Marketplace plan then something else very important to take into consideration when thinking about monthly premiums are those premium tax credits and how they relate to your mag AI which is modified adjusted gross income in order to determine your eligibility for those premium tax credits which can save you quite literally thousands of dollars per year the marketplace is going to ask you to estim at your mag AI for the upcoming year your Magi is very very similar to your AGI it can be slightly different based on certain deductions that you may take but it’s likely going to be pretty darn similar on healthcare.gov if you put in your ZIP code it’ll either take you to healthcare.gov or redirect you to your State’s individual Marketplace and then it’ll ask you a few simple questions to determine if you’re eligible for a premium tax credit and estimate what that might be so I highly recommend that you do click where it says says start tell you about you know who’s in your household let’s put us and other people continue we’ll put married I’m going to go through these as quickly as possible yes we’ll claim dependence let’s say two continue tell us about you 35-year-old male who is a legal parent continue and let’s say our spouse is a 35-year-old female who is also a parent continue and then let’s say we’ve got two twin boys quite a lovely family okay so this is our household confirm now we’re going to estimate our income so I want to show you this a couple different times so you see how that affects your premium tax credit so let’s say our total income is going to be 80,000 your estimated premium tax credit is $1,114 per month this is an estimate then if you were to view the plans let’s just skip this what you will see is that premium tax credit applied and what your estimated monthly premium would be I’m going to go back and I’m going to adjust the income that I put in let’s put 70,000 I want to put 70,000 this time this is why I wanted to look at this you may be eligible for extra savings if you pick a silver plan if this pops up for you that you may be eligible for extra savings with the silver plan please please please look at the silver plans very closely because with these extra cost savings on deductibles co-pays and Co Insurance it very often works out that a silver plan is actually going to be a better deal for you than even a platinum plan when you actually utilize your health insurance so take a look at that and then we can actually sort buy silver apply filters and you’ll see you’ll still have some pretty reasonably priced for a family plan silver plans that will offer you tremendous cost savings with those extra cost savings offered by silver plans now of course now of course if you wanted to skip these questions or you made significantly more money then you would see full priced plans which are going to be a lot more than what we were looking at before now remember these premium tax credits which are of course reflected in a discounted monthly premium are just tax credits paid up front so if you underestimate your income and you actually end up making too much money to qualify for a premium tax credit or to qualify for a premium tax credit of that size then you may have to pay that back when you file your taxes then there is your deductible this is the amount that you have to meet out of pocket before your insurance begins to contribute to the cost share which are co-pays or co- Insurance more than that in just a minute of course some services are actually covered even prior to meeting the deductible mostly basic and preventative Services or services that fall under the 10 essential benefits for ACA plans again more on that in just a moment as well now generally speaking there’s an inverse relationship between deductibles and premiums plans with higher monthly premiums tend to have lower deductibles and plans with higher deductibles tend to have lower monthly premiums there are even plans that can be specifically designated as high deductible health plans or hhps then there are co-pays and co- insurance so you pay your monthly premium to keep your insurance active once you’ve met your deductible you’re responsible for a co-pay or a co- insurance which is the cost share these are different though so a co-pay is a fixed amount for example it might cost you $25 to see your regular doctor $50 for a specialist and $250 for the emergency room co- insurance is a percentage so it could be 20% 15% 10% Etc of the actual bill so for example if you’re Co insur insurance for the ER was 40% and the ER trip actually cost 1,000 then your Co insurance after your deductible would be $400 another very important Financial figure to take into consideration is your PL outof pocket maximum now all plans will have some type of outof pocket maximum and this is designed to protect you from major medical bills basically your plan is keeping track of how much you are spending and should you reach this out-of-pocket maximum which is a financial threshold then your plan would take on the remainder of of your covered in network service bills for the remainder of the calendar year now every year the IRS sets a maximum outof pocket maximum for Families versus individual plans and in 2025 those numbers are 9,200 for an individual that is to say if you have an individual plan and 18,400 if you have a family plan now these numbers are actually down from 2024 which is a very good thing you want a lower out-of-pocket maximum so in 2024 the outof pocket maximum for an individual was 9,450 so that’s a decrease of 250 and for a family it was 18,900 so that’s a decrease of 500 I just want to pause for a brief moment to talk about family versus individual out of pocket maximums as well as family versus individual deductibles because they basically work the same way basically if you’re on a family plan you’ll notice that there is a family out of pocket maximum and an individual out of pocket maximum so if you as an individual independent of the rest of your family spending meet your individual out of pocket maximum then your covered in Network Services would be covered for the rest of the calendar year conversely let’s say you don’t have major medical needs but maybe you have a couple of siblings on your plan in addition to your parents maybe you haven’t even gone to the doctor this year but combined your family members have not only met their individual out of pocket maximums but they’ve actually together met the family out of pocket maximum then even though you haven’t spent at all because your family has met that outof pocket maximum then you would be covered as well and you wouldn’t have any bills for the remainder of the calendar year it works the same way with the deductible now as I mentioned even if you choose a plan with a higher deductible there are many services that will be provided prior to meeting that deductible so what I want to talk about now are those 10 essential benefits so these are the 10 essential benefits ambulatory patient services Emergency Services any type of hospitalization pregnancy maternity and newborn care that’s very important because those aren’t necessarily covered by something like a short-term medical plan mental health and substance use disorder Services prescription drugs also very important but you need to make sure that your prescription is included rehabilitative and habilitative services laboratory services preventative and wellness Services as well as chronic disease management and of course pediatric services including oral and Vision Care Now plans can choose to offer additional benefits but these are the 10 essential benefits that are guaranteed plants must also offer birth control coverage and breastfeeding coverage and then these are other benefits that of course can be added like dental and we’re going to talk about that later in the video now let’s talk about those metal tiers those oh so confusing metal tiers there are bronze plans silver plans gold plans and platinum plans and despite what you may think a platinum plan isn’t necessarily higher quality quity than a bronze plan these names really just have to do with the cost sharing structure and when I say cost sharing for these plans specifically what I’m talking about is co- insurance so generally speaking it breaks down that a bronze plan will have a 60/40 split meaning your insurance carrier will pay 60% and you’ll pay 40% silver is 7030 gold 8020 and platinum 9010 now that’s just usually how it breaks down and there are some other things to take into consideration as well so something like a bronze level plan because it has a higher cost share on your part generally speaking those have lower monthly premiums so these types of plans might be better for somebody with more limited medical needs who is looking to save money on their monthly premiums also something very very important about silver plans if you are eligible for premium tax credits you may be eligible for extra savings with a silver plan and if that’s the case if that’s you I’d highly encourage you to pay extra special attention to the silver plans because very often with those extra savings the cost sharing structure is actually more beneficial on a silver plan than a platinum plan then there are gold and platinum plans so you will have a lower cost share and usually speaking a higher monthly premium so these types of plans might be better for somebody who has more extensive medical needs basically you may be paying a little bit more in your monthly premium but significantly less when you actually have to utilize your health insurance earlier in the video I mentioned hhps which are high deductible health plans these are very important because very often they are offered in conjunction with an HSA which is a health savings account this is a money-saving tool as well as a wealth building tool which is very very popular within the fire Community Financial Independence retire early now every year the IRS sets a minimum deductible in order for a plan to be considered a high deductible and in 2025 that minimum deductible is 1,650 for someone who’s on an individual plan and that is a $50 increase now if you’re on a family plan the minimum deductible in order to be considered a high deductible Health Plan is $3,300 which is up $100 from 2024 but of course it tends to be on the higher side and can actually go all the way up to the out- of pocket maximum for 2025 as we’ve discussed plans with higher deductibles tend to be better for people with more limited medical needs on the flip side if you’re someone with extreme medical needs and you know you’re going to meet that deductible or even your out of pocket maximum extremely quickly then you could still consider a high deductible Health Plan hsas are the main draw though here hsas offer a triple tax advantage so the money that you contribute to your HSA which is your account with your money in it is actually pre-tax therefore lowering your taxable income not only does it lower your AGI but of course it lowers your M Ai and therefore it could actually push you into a lower tax bracket making you eligible for a larger premium tax credit now hsas themselves the accounts themselves are are actually interest bearing and that interest is also not taxable and that money will roll over from year to year you can withdraw the funds for a qualified medical expense and the list is truly extremely long and as long as you withdraw the funds for a qualified medical expense then there is no taxation or penalty but you don’t have to withdraw it you can let it roll over from year to year again it is AC crewing interest and if you hold on to it until you’re 65 then you can use it as you would a basic retirement account and there’s one more major benefit to hsas which is that you can actually invest a certain portion of it and the earnings on those Investments are again not taxed now on the marketplace you will likely see hmos and epos it’s highly unlikely that you’ll see ppos but it might however it’s very important that you understand the differences between the three a brief pause here if you like what you’re seeing and we hope you do please make sure to click like And subscribe as well to stay up to date now if you have any questions about your health insurance you can reach us in the comments below or at the number on the screen we are licensed Nationwide and there’s absolutely no charge for our services so if you want somebody to sort of take the guess work out of enrollment for 2025 please feel free to give us a call all right let’s get back to it so basically we have hmos on one end of the spectrum and ppos on the other with epos somewhere in between so with an HMO you will only have in network coverage with a PO you have in and out of network coverage with an EPO you only have in network coverage now with epos and hmos on in the marketplace the exception of course is in the case of a true medical emergency within with an HMO you need a PCP which is a primary care physic for a PO you don’t need a PCP for an HMO you need a referral for a specialist um you don’t need that with an EPO or with a PO and then of course hmos tend to have lower monthly premiums with ppos being on the higher end of the spectrum and epos being somewhere in between so now that you have a pretty good understanding of the ins and outs of Market replace plans let’s take a look at the actual plans themselves so we can finally preview health insurance plans on healthcare.gov now of course if your state does not use healthcare.gov when you put in your ZIP code it will prompt you to go to your State’s individual Marketplace website so let’s put in some information we’re going to skip this all right let’s say it is Us and other people we’ll put that we are married and that we have two dependents let’s say we are a 35-year-old male who is the legal parent of a child married to a 35-year-old female who is also the legal parent of a child and one of our children is two and one of our children is five you confirm all of your household information is correct and move right along and we will estimate our income let’s say we have estimate our income at 75,000 remember that is the total household income that’s not just your income as the person who is looking at the plans continue So based on the information that we have put in it’s estimated that we will receive a premium tax credit of $1,339 per month so when you view the plans you will see that discount applied also based on the information that I put in you’ll see you may eligible for extra savings if you pick a silver plan and this is a great thing B basically as I said earlier those silver plans have a 7030 co- Insurance split however if you’re eligible for extra savings then very often your co- insurance is even lower on a silver plan and as you can see here there’s extra savings on cost like deductibles co-pays and co- insurance so if you are eligible for extra savings with a silver plan I highly encourage you to give those silver plans a little extra attention view plans this is just the popup that shows you how to use the website basically I’m just going to click out of this so right now it is filtering based on lowest premium you can of course filter by lowest deductible if you need that instead right now we’re looking at health plans if you needed dental plans you would go here now let’s look at the filters so monthly premium range let’s say that you can only spend for your family $500 now let’s say we really want to look at these silver plans um anything else that we want to put put in now if you know that you need an EPO oh there are some ppos available how wonderful is that but let’s say you definitely know that you need the flexibility of an EPO because you don’t want to need a referral to see a specialist anything else if you know that the doctor that you already see or the hospital that you use only takes certain insurance plans then you would make sure to apply that as well now if you’re really really interested in an HSA if that’s something that really appeals for you you would click eligible for an HSA and then of course medical providers if you already have your doctors that you see make sure you click that there as well so that way you can make sure that your doctor accepts this plan and for prescription drugs you would of course do the same so let’s apply these filters and see what we come up with so now we are down to 13 plans let’s take a look so we’ve got this one the premiums come in at $265 62 with a $9,500 deductible and an outof pocket maximum the family total of 14,700 now when you click view full details you will see more information in just a moment let’s see what else we have okay another Oscar now of course the plans that we’re looking at are going to be pretty similar right now because of all the filters that I’ve applied but this is basically going to be a brief snapshot of some of the important information like how much you pay for your primary care versus a specialist versus an Urgent Care 40% Co insurance after you’re deductible oo for the emergency room that’s pretty expensive not going to lie this one $40 for Primary Care 80 60% after deductible now let’s say these three plans were of interest to us we would C we would click compare plans right here and then you compare those three plans usually you can compare up to three plans so let’s take a look so our monthly premiums they’re pretty comparable in all honesty you can see that that $1,339 tax credit was applied this plan has the lowest deductible for individuals and for families which is certainly very helpful let’s see and this is silver classic standard scroll on down plan documents this is where you’d find your summary of benefits very important costs for medical care all right let’s take a look so we’re only going to see in network coverage because this is an EPO um let’s take a look at some of these costs so the deductible we’ve already discussed over here out of pocket maximum 6,400 for an individual 12,800 for a family so this is also the lowest Primary Care $10 from Day One $40 from day one the reason it’s telling you from day one is meaning you don’t have to meet your deductible prior to having access to your primary care physician your PCP specialist visits also covered from day one X-rays and diagnostic 40% co- insurance after deductible laboratory outpatient $10 40% Co insurance after deductible so that’s a big difference here let a very big difference here um basically we’re looking at $10 and this one’s the deductible plus 40% huge difference outpatient facility all comparable outpatient Professional Services all comparable hearing aids are almost never covered routine eye exam not covered eye exam for children covered eyeglasses for children covered none of these offer an HSA prescriptions so we’re going to see the tear here and so we didn’t put any prescription medications in but if you do take prescription medications please make sure to put that in that’s very important when comparing plans um many plans break them down into these tiers generic drugs being the least expensive with usually specialty drugs being the most expensive then you can view the list of covered drugs here offers mail order pharmacy for a 3-mth supply prescription drug deu dble is included in the plan deductible sometimes there can be a separate deductible access to hospitals and doctors this is just saying that it’s not a PO urgent care and Hospital services this is breaking down those costs a little further although we did sort of already go over those costs these are always the same examples which is the typical cost for a healthy pregnancy typical cost for managing type 2 diabetes and typical cost for a treatment of a simple fracture now this isn’t necessarily the most helpful especially not this typical cost or treatment of a simple fracture it’s not like you’re planning on that happening but if you are pregnant or planning on becoming pregnant then this is actually very helpful um if you do in fact have type 2 diabetes this is very helpful so this isn’t going to help you you know in multiple situations basically just these three situations but it’s just a brief snapshot that shows you what the cost might be for these types of circumstances we already know that the dental is not covered for adults any medical management programs you can find those here now if I wanted to really investigate one of these plans more thoroughly let’s say I wanted to investigate this plan more thoroughly what you would want to do is go over here where it says summary of benefits and this is a more thorough breakdown of the benefits offered and the costs associated let’s go back to the plans we’re going to get rid of these filters that we have applied so now we’re back to 178 plans 64 of those had extra savings let’s say that you really really wanted a plan that was eligible for an HSA let’s apply that one filter so now we’ve dropped down to just two plans one at 450 and one at 1,300 I’m sorry one at $1,397 cents it’s a significant difference well but this is 5% after you’ve met your deductible yeah so you have to meet your deductible for basically everything just looking at these you know briefly I got to be honest they don’t seem like great plans um the premium is still well certainly not this one it’s very expensive um you know the premium is a little bit higher um the deductible and outof pocket maximum are of course much higher as I said they would like be let me just look at these plan details actually yeah let’s go to the plan details take a look deductible costs for medical care yeah basically to do anything except for some of those more pre you know some of the preventative Services offered under the 10 essential benefits um basically for anything you’re first going to have to meet that deductibility of $6,650 which is pretty significant now of course you can contribute a significant amount to your HSA and perhaps that’s something that’s very very important to you but in my estimation it seems like somebody that is looking into in this type of plan this one specifically with those much higher deductibles um very few services covered prior to meeting the deductible this seems like somebody who’s really using their insurance as an investment tool and a wealth building tool rather than Prim arily to cover their health concerns so this type of plan with this very very high deductible and very few services covered prior to meeting the deductible this would really be good for someone who is looking for wealth management tools and who has minimal health concerns because if you’re somebody that does have regular health concerns this plan is going to end up costing you a lot of money let’s get rid of this I also want to take a look at the ppos since as we’ve discovered there are or few ppos available that is very unusual so that’s really nice to see that gives you so much more flexibility of course as I mentioned earlier ppos tend to have higher monthly premiums and that’s exactly what we’re seeing already that these premiums are much higher than the ones that we were looking at even when we were just looking at epos that being said it’s going to provide you coverage out of network as well so if you need to go out of network if the even if you know right now that there are no epos that that offer you um a provider that you need to see that is in network then a PO is the better way to go because even though this premium is higher yes you’re not going to have to pay the full cost out of network which you would have to do with an EPO now you may or may not have noticed that some of the plans in the marketplace offer dental coverage and I just want to caution you here because sometimes those networks for dental plans can be rather restrictive especially if we’re talking about a dhmo and private dental insurance can actually be very very inexpensive so if you do want learn more about your dental insurance.