Purchasing Marketplace Insurance: Seven Important Factors To Consider

You may think that you will never find yourself shopping for health insurance. Employer sponsored plans have been more than sufficient and fulfilled your needs until now. However, what happens if you become injured or ill and are unable to work or you lose your job? Understanding how the health marketplace works can turn a mind-boggling experience into an easily understood one.   

If you have always depended on an employer-sponsored plan you may not have thoroughly investigated different options that are available to you. When choosing an insurance product you want to include the following in your decision making process:


Deductibles are the amount you are responsible for before your co-insurance starts to cover a portion of your costs. Some plans offer a percentage of coverage for routine visits and tests prior to reaching your deductible limit. Most plans cover a majority of preventative visits and procedures.

 It is important to remember that if you are switching policies prior to the end of your insurance term that what you have already paid toward your deductible will not follow you and will instead be reset to zero. If you have a family plan, you will have a single and family deductible amount.  


Co-insurance is the percentage that your policy will cover once your deductible is met. Plans from the marketplace usually carry names that include bronze, silver, gold, and platinum. The more precious the metal in the name, the higher the percentage of coverage will be included for in-network procedures.


Co-pays are what you will pay out of pocket for visits and procedures. This is usually paid at the point of service such as your doctor's office, urgent care, or laboratory.

Out of Pocket Maximum

Your out of pocket maximum is what you can expect to pay out of pocket for medical visits and procedures during the year. If you have a family plan, you will have both a single and family maximum amount. 

Current Care Coverage

It is important to check to see if the insurance you are considering requires an in-network provider, and if your provider is part of their network. If not, you may end up paying higher co-pays and overall costs to continue with your current care provider. 

This is extremely important to those who are receiving care through cancer treatment centers or other specialized clinics. Ensuring that ALL of your providers are part of the insurance network will reduce your out of pocket and overall costs. 

If your current insurance is covering costs of investigative treatment or clinical trials, you should also talk to a representative about continued coverage for these items. 

Prescription Coverage

Prescription coverage is hugely important to those who take regular medication for chronic or acute conditions. You do not want to be blindsided by sudden increased medication costs or the inability to continue taking the type and brand of medication you are currently using.

Out-of-Network Coverage

If you are a frequent traveler, you may want to investigate supplemental plans that offer more coverage for out-of-network doctors and areas outside your current plan area.

Take the time to investigate your insurance choices and thoroughly understand your options.  If your income has been reduced, you may qualify for state or federal programs that can reduce the costs of your monthly premiums and your overall health related expenses.

Contact a professional insurance agency, like Bailey Insurance Services, to discuss your options.