How to Pick the BEST Marketplace Plan 2025

How to Pick the BEST Marketplace Plan 2025 - Before you buy health insurance, watch this ultimate guide! Learn about the master price list, coinsurance vs copay, and managing health costs as a self-employed individual in the United States.
Ultimate Health Insurance Guide | The last video you need before buying policy!-
Welcome to health insurance 101: marketplace insurance, open enrollment, hmo vs. ppo and more!

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★☆★ABOUT THIS VIDEO★☆★
0:00 Intro
0:17 Understanding Costs
7:42 10 Essential Benefits
8:45 Metal Tiers
10:25 HSA & HDHP
12:30 HMP vs EPO vs PPO
13:55 2025 Plans


First let’s talk about monthly premiums. This is fairly easy to understand. Your monthly premium is the amount you pay monthly to keep your insurance active. If you don’t pay your monthly premium, you won’t have insurance. Compare your monthly premium with your deductible, copays and coinsurance and out of pocket mac.
Also, look at the benefits offered and the networks. Paying less for a plan but none of your doctors are in network, will not serve you. On the flip side, paying more for a plan that offers many fringe benefits that you don’t necessarily need is a waste of money.

If you are buying a plan on the marketplace, you need to understand how premium tax credits work.
A premium tax credit is just a tax credit paid upfront and it is reflected in a discounted monthly premium. You may be eligible for a premium tax credit based on your income and household size. You will find out if you are eligible for a premium tax credit by answering a few simple questions on healthcare.gov

The next financial term to understand is your deductible. This is the amount that you must meet out of pocket (or at full cost) before your insurance begins to contribute to the cost share.

You should know that very often plans with higher deductibles have lower premiums and vice versa. There is usually an inverse relationship.

If you are someone with more extensive medical needs, you may benefit from a plan with a higher monthly premium, but lower deductible. For those with more basic medical needs, lower premiums, with a higher deductible may be the way to go.

And remember many services such as preventative care and wellness visits are covered even prior to meeting your deductible. These are part of the 10 essential benefits.

A little bit more on copays and coinsurance. These are your cost sharing bills you will be responsible for once you have met your deductible. A copay is a fixed amount. For example, you might have a copay of $25 to see your doctor, $50 for the urgent care and $250 for the ER.

Coinsurance is a variable amount. It is a percentage of the cost. So, using our example above, you might have a 25% coinsurance for inpatient care. So, your bill is determined by the cost of the service.

If you’ve seen the metal tiers on the marketplace, these metal tiers really indicate the cost sharing or coinsurance structure.

There are 4 tiers:
Bronze- 60/40
Silver- 70/30
Gold-80/20
Platinum 90/10

Usually platinum plans will have more expensive premiums than bronze plans because that amount is made up when you actually use your insurance.

Another term and number to be familiar with is the OOP Max. This is the maximum that you can be billed in a plan’s year.

So, if you have to have a planned medical procedure, you might want to aim for earlier in your plan’s calendar year to save on medical expenses unless you’ve already met your OOP MAX. Then you want to try to plan it before your plan’s calendar year resets.

Now one of the most basic decisions that you need to make is between an HMO, PPO or EPO. HMOs will have lower premiums and less flexibility. PPOs will have higher monthly premiums and more flexibility. EPOs are somewhere in between.

Some more acronyms you may hear tossed around are HDHP and HSA.
HDHPs are high deductible health plans. These may be popular for people with limited health needs looking to take advantage of a lower premium They may also be popular for those wishing to invest in an HSA which is a health savings account because they offer a triple tax advantage.


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