Buying a health plan on the Marketplace
Have questions or need assistance?
The Blues are here to answer your questions. Call a Blues Health Plan Advisor at 1-855-269-9898
or your independent Blues agent for assistance. You may also visit www.bcbsm.com/getinsurance to compare plans.
Important dates to remember
Prepare to buy
Our handy worksheet will help you organize the information you’ll need for an easy and efficient call.
Select the description that best fits you.
You'll be best prepared to speak to a Health Plan Advisor if you print and complete the worksheet. If you don't have access to a printer, you can still continue on the site and gain an understanding of what you'll need to enroll.
Uninsured & Employed
"I don’t have health coverage. I can get a health plan through my employer (or my family member’s employer), but it doesn’t meet the requirements of the law."
Insured Through a Family Member’s Employer
"I have health coverage through a family member or legal guardian who has a health plan through their employer."
Insured Individual Purchaser
(without an option to buy through an employer)
"I have health coverage that I bought myself or a family member bought – I don’t have access to a health plan through an employer or family member’s employer."
Insured Through Employer
"I have health coverage through an employer or family member’s employer."
To use a worksheet
To proceed without a worksheet
Click on the bars below to understand the difference between HMO and PPO plans, and to be prepared for your enrollment conversation.
Basic healthcare terms
Here are the most common items that make up a health plan.
The fixed dollar amount you pay to your health plan carrier – usually monthly – for health coverage, similar to rent or cable bill.
A fixed dollar amount (for example, $20) you pay to the provider, like a doctor, at the time of a health care service.
A fixed dollar amount you pay for most medical services before your health plan company starts to pay for the medical expense. In some health plans you don’t have to pay your deductible before your health plan covers the cost of some services such as preventive care like check-ups and regular doctor visits.
A fixed percentage that is your share of the costs of your covered health care services after a deductible is met.
The maximum dollar amount you pay in deductibles and coinsurance during one plan year.
A subsidy is a kind of financial assistance that helps you pay for something – in this case, a health plan.
Cost-sharing assistance lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance and copayments. These are costs you have to pay when you get care.
Advance premium tax credit:
Advance premium tax credit is financial assistance that helps in paying part of your monthly health plan premium and lowers the amount of the monthly premium that you have to pay. This type of financial assistance is sent directly to your health plan company monthly.
Essential health benefits:
All health plans on the Health Insurance Marketplace should include a standard set of basic medical benefits.
Here's an example of how some of these terms work together.
Your monthly costs
What you will pay out of pocket at time of incident
- Copayment (or copay)
The benefits you receive
- Essential Health Benefits
The amount your insurer will pay
HMO and PPO plans
Both types of plans use a network of physicians, hospitals and other health care professionals to give you the highest quality care. The difference between the two is the way you interact with those networks.
HMO stands for Health Maintenance Organization. With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. That means that you generally need a referral before you can see any other health care professional (exceptions include emergency and obstetrical services). Visits to health care professionals outside of your network typically aren’t covered by your health plan.
PPO stands for Preferred Provider Organization. PPO plans give you flexibility. You don’t need a primary care physician. You can go to any health care professional you want without a referral – inside or outside of your network. Staying inside your network means lower copays and full coverage. If you choose to go outside your network, you'll have higher out-of-pocket costs, and not all services may be covered.
Which one is right for you?
If you prefer to have your care coordinated through a single doctor, an HMO plan might be right for you. If you want greater flexibility or if you see a lot of specialists, a PPO plan might be what you’re looking for.
Determine when you want your coverage to begin, so you'll know when to enroll.
Verify the coverage offered to you (through your employer or your family member's employer)
meets the affordability guidelines in the reform law.
the cost of a plan from your employer (that would cover you and not any other members of your family)
is more than...
9.56% of your household income for the year
then... you may be eligible for a tax credit on the Marketplace.
Your household income $ __________ x .0956 = $ __________
If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you will lose the employer contribution (if any) to the employer-offered coverage.
Your employer may have provided you with a Health Insurance Marketplace Coverage summary statement (also known as employer notification) that includes information about the health plans they offer.
Find out if (and how much) financial help you may be eligible to receive.
Government financial aid is only available when you purchase plans sold on the Marketplace. You can get help buying a Marketplace product through health plan companies, health plan agents, or brokers. For a reminder of the types of aid available, like the advance premium tax credit or cost-sharing assistance, refer to Step.
To find out if you might qualify for aid:
1) Estimate your 2015 household income. Include income from all household members.
- Be sure to include any earnings from unemployment.
- Anticipate changes in your income, whether it might increase or decrease.
- Record your estimate.
2) Click HERE to find out how much financial help you may be eligible to receive.
When you file your taxes by April 15, 2016, the government will reconcile your actual income against what you estimated. If you earned more than you had estimated for 2015, you will owe the government money for your health plan. If you made less, the government will reimburse you through a higher tax refund or a reduced tax payment.
Add up how much you spent on medical care last year.
When considering what you spent, include things like:
- Doctor visits
- Urgent care visits
- ER visits
- Specialized treatments
Plan your health care budget for 2014, including any financial help you might be able to receive.
Step 4 (Estimate of financial help) $ ____________
Step 5 (Last year's medical expenses) $ ____________ +
Total (Your 2014 health care budget) $ ____________ =
Think about how much of the total you wrote down might go toward a monthly premium.
Consider how much you might start putting aside for an emergency (out‑of‑pocket costs, like deductibles).
* Keep this balance in mind. It will help you as you consider what plans are appropriate for you.
Review the list of health plans from your employer (or your family member's employer). Then compare the options to determine which plan may be right for you. Consider:
- Out-of-pocket maximum
- Your special coverage needs
When you choose an employer health plan, you pay your portion of the premium with pre-taxed dollars. This means that the cost is taken from your paycheck before you pay taxes on the amount.
Use the interactive chart below to understand how health plans and metal tiers work and to get an idea of monthly premium cost ranges.
All health plans from all companies on the Marketplace are arranged by metal levels: Bronze, Silver, Gold and Platinum. Each metal level represents the portion of health care costs that you pay and the portion that will be paid by the health plan company. The actual portion of costs you pay will vary, based on the specifics of the health plan you buy.
Understand monthly plan costs (your premium).
Let’s take a bird’s eye view of premiums for plans on the Marketplace in a few sample Michigan counties. The range of costs for plans in your county may vary – this chart is an example to give you an idea of the range in plan costs. Note that this chart does not indicate premium ranges for tobacco users.
monthly premium per member
Remember: the premium is one part of your health plan. Be sure to compare deductibles, co-pays and co-insurance as well.
Platinum plans are available in certain regions.
Collect the following information for each household member who may be covered by your health plan.
Employer and income information.
This can be pay stubs, W-2 forms or your tax return. If someone in your household has access to a health plan through their employer, you will be asked for that information as well.
Social Security number (or document number for documented immigrants)
Address (if different from yours) and contact information.
If you will be applying for financial help, you will need to reference your 2014 household income estimate from Step 4.
Congratulations! With your worksheet handy, you are ready to contact a Health Plan Advisor for help buying a new plan.