What is The Health Insurance Marketplace?

If you want health insurance in the United States, you have to buy it through the health insurance marketplace. Through HealthCare.gov, enrollees can purchase health insurance that meets ACA (Affordable Care Act) mandates, which provides government-standardized and regulated plans at a reduced premium depending on your situation. But how do you get a lower health insurance marketplace premium? 

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What Health Coverage is Required?

First thing’s first. To be part of the ACA Health Insurance Marketplace, a plan must meet certain government-mandated standards. These standards include ten essential benefits:

  • Hospitalization
  • Ambulatory services
  • Emergency Services
  • Maternity and newborn care
  • Metal health and substance abuse disorder care
  • Prescription drugs
  • Laboratory tests
  • Preventative services including immunization, contraception, screening for various illnesses, etc
  • Pediatric services
  • Rehabilitative services

How to Lower Your Health Insurance Premiums

#1. Assess Your Premium Tax Credits

One way to lower your health insurance premiums is to apply for a premium tax credit through the marketplace. In turn, they’ll pay your full or partial credit directly to your insurer, resulting in lower monthly premiums. The tax credit is primarily based on your household income and family situation. So if your household gains a member, you’ll qualify for a lower monthly premium, thanks to the tax credit. If your household loses a member, the opposite is true – your monthly premium will be higher. To qualify, you must not be eligible for coverage through Medicaid or Medicare or have access to affordable coverage through your employer.

Also – note that if you have a change in situation over the year (i.e., your income increases), you might have to pay back some of the tax credits. 

#2: Know How Health Insurance Plans Work

Before signing up for any health insurance plan, make sure you understand precisely what you’re paying for

Do you know what a deductible is? That’s the amount you have to pay for covered services before your insurance kicks in. Or how about copayment? That’s the share you pay for a medical service or item. Then, there’s coinsurance – your percentage of the cost for covered services. Finally, there’s the premium, which is the amount you pay for your insurance each month. And then there’s the network, which are the doctors, hospitals and clinics your health insurer covers as far as getting services go. 

#3: Work-Sponsored Health Plans

If you have a job that offers their own health insurance coverage, typically, the cost would be lower than buying it on your own. This is because the monthly premiums are split between the employer and employee, and family members would be covered.  

#4 Look into a Health Savings Account (HSA)

A Health Savings Account (HSA) is a type of savings account that allows you to put assigned pre-tax income to pay for covered medical services. This is a good way of lowering your healthcare costs. However, you can only contribute to an HSA if you have a High Deductible Health Plan (HDHP), which covers preventative services before the deductible. 

#5 Talk to a Health Insurance Pro

If you’re confused by all of the health insurance options out there, your best bet would be to talk to a Health Insurance Pro. Expert advice is only a phone call away – call 1-844-612-0518 -our fully licensed agents are waiting to help you!

#6 Be Mindful of Health Factors that Affect Your Premiums

Another thing worth thinking about is the various health factors that can increase your deductible. Unfortunately, some factors that affect coverage, such as your age and location, aren’t things you can change. However, one thing you can do to lower your monthly premiums is to give up smoking. According to HealthCare.Gov, insurers may charge up to 50% more for those who use tobacco than those who don’t! However, rest assured that things like gender and medical history do not affect your premiums, and all plans must cover pre-existing conditions from the day your coverage starts. 

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#7 Increase your deductible

One way to lower your monthly costs is to increase the deductible on your health care plan. However, bear in mind that while your monthly fees may be lower, you will have to pay a larger share of your healthcare costs before your insurance kicks in should you get sick. So you may save money upfront, but in the long term, it may not be worth it. 

#8 Change your coinsurance ratio

You can also increase your coinsurance ratio. Coinsurance is the percentage of costs for covered healthcare services you pay. For example, if your coinsurance ratio is 20%, you’d pay 20% of the cost of the service while your insurer would pay the rest. Plans with higher coinsurance have cheaper monthly premiums but, again, may not save you money in the long term. 

#9 Choose an in-network doctor

One thing worth considering when choosing health insurance is the health care network. You must visit health care professionals in your network to be covered under your plan. Depending on the kind of plan, you may have to pay more money if you see an out-of-network doctor if the reason is for non-emergency care. However, you will not be penalized if you’re forced to go outside the network for an emergency. If you already have a healthcare provider, you might want to double-check that they’re part of your plan’s network before signing up. 

#10 Reassess Your Health Insurance Regularly

Many factors affect the kind of health insurance you need. For example, if you’re an individual with good health, you can get away with paying a lower premium for a less comprehensive plan. However, when your family situation changes, so do your needs, so it’s important to reassess every once in a while to ensure you’ve got the right kind of health insurance.

#11 Always Shop Around & Compare Health Insurance Plans

When you sign up for health insurance, you choose a “tier,” which is always Bronze, Silver, Gold or Platinum. The higher you go up the scale, the higher the amount of health care costs your plan pays, although your monthly deductible is higher. 

Health Insurance tier Healthcare costs covered (%)
Bronze 60%
Silver 70%
Gold 80%
Platinum 90%


Don’t just sign up for the first health insurance plan you find. The costs can be high, and you want to make sure that all your health care needs are being met without the cost being too prohibitive. 

#12 See if You Qualify for Medicaid

Another option is to see if you qualify for Medicaid, the nation’s public health insurance program for those with low incomes. If you think you are eligible, visit the Medicaid website to check the criteria and apply. 

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