Choosing the Right ACA Health Plan for Your Needs: A Guide for Young Adults

Recently, a young person sought advice on about choosing the right ACA (Affordable Care Act) health insurance plan. While the specific details of their situation may not apply to everyone, there are some general principles that can help young adults navigate the ACA marketplace and find a plan that meets their needs.

Understanding Tax Credits and Co-pays

The ACA provides tax credits to help people afford health insurance premiums. You can either have the tax credit applied directly to your monthly premium, or you can receive it as a lump sum when you file your taxes.

If you choose a plan with a deductible, you will typically have a co-pay for office visits. A co-pay is a fixed amount that you pay for a specific service, such as a doctor’s visit or prescription. Deductibles and co-pays are not the same thing. A deductible is the amount you must pay out-of-pocket before your insurance begins to cover costs. Co-pays are payments you make for specific services, regardless of whether you have met your deductible.

Consider Your Healthcare Needs

When choosing a plan, it’s important to consider your expected healthcare needs. If you have ongoing health conditions or expect to use medical services frequently, you may want to choose a plan with a lower deductible. This will help you save money on out-of-pocket costs.

If you are generally healthy and do not expect to use medical services often, you may be able to save money by choosing a plan with a higher deductible. Just be sure to factor in the potential out-of-pocket costs if you do need to use medical services.

Look for Plans with Co-pays for Primary Care and Specialists

Some plans may require you to pay the deductible before co-pays apply. This means you could have to pay the full cost of a doctor’s visit or specialist appointment until you meet your deductible.

If you expect to use medical services frequently, it’s a good idea to choose a plan that includes co-pays for primary care and specialists without a deductible requirement. This will help you save money on out-of-pocket costs.

Consider Surgical Services and Diagnostic Imaging

If you have any specific health concerns, such as chronic digestive issues or sinus problems, consider choosing a plan that includes co-pays for surgical services and diagnostic imaging. This will help you save money if you need to undergo these procedures.

Seek Professional Help

The ACA marketplace can be complex and confusing. If you need help choosing a plan, consider seeking professional help from a licensed insurance agent. They can help you understand your options and find a plan that meets your needs and budget.