Individual & Family Plans

Premium

Your premium is what you will pay each month to have health insurance.

It’s like your monthly fee for your favorite TV streaming service. Even if you only watch one or two shows a month, you still pay the same monthly fee for access. If you buy through our Marketplace or HealthCare.gov, you may be able to lower your costs with a tax credit that goes toward your monthly premium.

Deductible

Your deductible is what you pay every year for health care before your insurance company starts paying. Usually, high deductible plans have lower monthly premiums.

For example: If you have a $2,000 deductible, your insurance company might not pay until you’ve paid $2,000 in health care costs.

Some plans may cover costs for things like an annual check-up before you’ve paid your full deductible. When you’re shopping for plans, look at what counts toward the deductible.

Coinsurance

After you have paid your deductible for the year, you still might have to pay a part of your medical expenses. This is called coinsurance.

For example: Say your plan has a 20% coinsurance and $2,000 deductible. If you reach your deductible halfway through the year, you’ll pay $20 of a future $100 bill. Then your insurance company would pay the other $80.

Not all plans have coinsurance, so make sure to see if the plan you’re looking at does.

Out-of-Pocket Maximum

This is the total you’ll pay each year toward your medical costs. It combines your deductible costs, copay and coinsurance.

Once you reach your out-of-pocket maximum, your insurance company will pay for the rest of your approved health care.

Premiums don’t count toward your out-of-pocket maximum. Also, out-of-network provider bills may not count.

• Bronze
• Silver
• Gold
• Platinum

The most important things you need to think about are:

• Monthly cost: How much can you afford to pay each month in your premium
• How often you see your provider: If you routinely need care, you might want to pick a plan that has lower costs for care

Open Enrollment is the time of year when you can pick a health insurance plan.

If you’re shopping for individual coverage and don’t qualify for a plan through your employer, open enrollment is November 1 through January 15.

You’ll only be able to change your health insurance outside of open enrollment if you qualify for a Special Enrollment Period.

Yes, if you shop for GHC-SCW plans through this link, you can still qualify for government tax credits toward your monthly premiums. It will take into account your age, how many people are in your household and your total income to determine if you qualify.

Bronze

• Low monthly premium
• High costs when you need care
• Deductibles: you may pay thousands a year in medical costs before your health plan starts to pay
• Choose if: You want to keep your monthly costs low while also protecting yourself from high-cost emergency medical issues. You’ll have to pay more when you need to see your provider for routine care.

Silver

• Medium monthly premium
• Medium costs when you need care
• Choose if: you qualify for cost-sharing reductions or if you want more of your routine care to be covered by your health insurance plan in exchange for a slightly higher monthly premium.

Gold

• High monthly premium
• Low costs when you need care
• Choose if: You think you’ll need to see your provider often because of routine care or illness. You’re going to pay more each month, but your out-of-pocket costs will be lower.

Platinum

• Highest monthly premium
• Lowest costs when you get care
• Choose if: You want nearly all of your care costs to be covered in exchange for paying more each month for your premium.