Choosing a health plan is one of the most important decisions you'll make for you and your family. It can also be one of the most challenging. You're likely to come across a lot of terms and phrases that you haven't encountered before. That's why we've created this guide to help you compare health plans and choose the right one for your budget and health needs.
We'll go over Individual and family health plans, which are plans for people who are purchasing their own health coverage.
Compare and shop for plans
One of the first steps in choosing a health plan is understanding your coverage options and how they fit your budget and health care needs.
When you shop for a MyPriority® plan, you can compare available plans, review benefits and costs, and see whether you qualify for financial assistance. Based on the household and income information you provide, we'll check your eligibility for premium tax credits and other savings that may help lower your health care costs.
Even if you're not currently eligible to enroll because it's outside the Open Enrollment Period, you can still explore plan options and prepare for enrollment. If you experience a qualifying life event, you may be eligible to enroll through a Special Enrollment Period.
What is the Open Enrollment Period?
Unless you experience a qualifying life event, you can enroll in a new health plan only during the Open Enrollment Period, which runs each year from Nov. 1 through Jan. 15. If you enroll by Dec. 15, your coverage begins Jan. 1. If you enroll between Dec. 16 and Jan. 15, your coverage begins Feb. 1. To activate your coverage, you must complete the final step to enrolling by paying your first premium.
After Jan. 15, individuals and families can only sign up for a health plan if they qualify for a Special Enrollment Period.
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) lets you enroll in a health plan outside of the Open Enrollment Period if you experience a qualifying life event, like losing coverage, getting married, moving or having a baby. You typically have 60 days from the event to enroll.
Key factors to consider when comparing health plans
Understanding HMO plans
MyPriority Individual and family plans are Health Maintenance Organization (HMO) plans. HMO plans generally offer lower costs in exchange for receiving care from a network of participating providers. To get the most value from your coverage, you'll typically need to use in-network doctors, hospitals and other health care providers.
Before choosing a plan, it's important to confirm that your preferred providers are included in the network. Learn more about how health plan networks work.
What about a Health Savings Account?
A Health Savings Account (HSA) is a smart way to set aside money for qualified healthcare expenses while enjoying valuable tax advantages. Funds can be used for eligible medical, prescription, dental, and vision expenses, and unused balances can continue to grow over time.
Under the One Big Beautiful Bill Act, all Bronze plans available through the Marketplace are eligible for HSA participation. With a MyPriority Bronze plan, you'll have access to an easy-to-use HSA through HealthEquity®, featuring free administration, convenient account management and dedicated support throughout your healthcare journey.
What does plan metal level mean?
Another term unique to comparing Individual and Family health plans is the metal level: Bronze, Silver and Gold plans. These levels represent how costs are split between the plan holder and the health coverage provider.
For example, with a Bronze plan, the individual might pay about 40% while the coverage provider pays 60%, resulting in lower premiums. In contrast, a Gold plan will cover around 80% of expenses, leaving 20% for the members, but these plans usually have the highest premiums. Learn how to choose an ACA plan based on how you use care.