For most people this is the first time they've ever shopped for their own health insurance. It's less scary than it sounds, and you have a real advantage: you're spending an allowance, so you can optimize for the plan that fits you rather than the cheapest sticker price.
Where to shop
- The Marketplace — HealthCare.gov, or your state's own exchange. Every plan here is a full ACA-compliant plan. This is the default for most people.
- Directly from a carrier ("off-exchange") — same rules, sometimes different plan lineups, and generally the only route if your employer offers pre-tax payroll deduction for your share.
- Through your employer's broker or ICHRA administrator — many provide a shopping tool that already knows your allowance and shows your net cost.
The metal tiers, decoded
| Tier | Plan pays (roughly) | Typical fit |
|---|
| Bronze | ~60% | Lowest premium, highest deductible. Healthy, rarely go to the doctor, comfortable with risk. Often HSA-eligible. |
| Silver | ~70% | The middle. Also the benchmark plan used for the affordability test. |
| Gold | ~80% | Higher premium, lower deductible. Ongoing prescriptions, a known procedure coming, or a family that uses care. |
| Platinum | ~90% | Highest premium, lowest out-of-pocket. Rare, and not offered everywhere. |
The pattern: premiums and deductibles move in opposite directions. Your allowance can let you "buy up" to gold for a small net cost — for many families that's the best move they make all year.
The four questions
- Are my doctors and hospital in the network? Individual-market networks are often narrower than group plans. Check the carrier's directory — and then call the office to confirm. This matters more than anything else on the list.
- Are my prescriptions on the formulary, and at what tier? Look up each one. A drug that's tier 2 on one plan and non-formulary on another can swing your year by thousands.
- What's the most I could owe in a bad year? That's the out-of-pocket maximum. Premium × 12 + out-of-pocket max = your worst case. Compare that number, not just the premium.
- Do I want an HSA? If yes, filter for HSA-eligible (HDHP) plans and read HSAs and your ICHRA first — there's a catch.
Comparing two plans with a $500 allowance
Bronze: $380 premium, $7,000 deductiblenet $0/mo
Gold: $610 premium, $1,500 deductiblenet $110/mo
The gold plan costs $1,320 more per year in premiums but lowers the deductible by $5,500. Someone with regular prescriptions or a planned surgery typically comes out ahead on gold. Someone who sees a doctor once a year typically comes out ahead on bronze — and the unused $120 of allowance generally stays with the employer either way.
Things that trip people up
- Buying the cheapest plan reflexively. You're leaving allowance on the table and taking on a big deductible for no reason.
- Assuming a PPO. Many individual-market plans are HMOs or EPOs with no out-of-network coverage at all. Read the plan type.
- Skipping the plan's Summary of Benefits. It's a standardized two-page document; the first page answers 80% of your questions.
- Forgetting the deadline. Your plan must be active on your ICHRA start date. Enrollment windows are firm.
Want the step-by-step version? The Enrollment Walkthrough uses your real visits, prescriptions, and priorities to compare plans.