Shopping for an individual health plan on the ACA marketplace can feel overwhelming — especially the first time. Here’s a step-by-step process that makes it manageable.
Step 1: Gather Your Information
Before you start, have these ready:
- Social Security numbers for everyone in your household
- Estimated household income for the coming year
- Current health insurance information (if any)
- Your doctors’ names and any prescription medications you take
Step 2: Estimate Your Income
Your subsidy eligibility is based on your projected income for the upcoming coverage year — not last year’s income. If you’re self-employed, estimate your net income after business deductions. If your income is uncertain, use your best estimate — you can update it if things change.
Step 3: Understand Your Subsidy
Enter your household size and estimated income at healthcare.gov or work with a broker to calculate your premium tax credit. This tells you what plans will actually cost you after subsidies — a much more useful number than the list price.
Step 4: Compare Plans
Don’t just look at the monthly premium. For each plan you’re considering, check:
- Deductible (what you pay before insurance kicks in)
- Copays and coinsurance for common services
- Out-of-pocket maximum (your worst-case annual cost)
- Whether your doctors are in-network
- Whether your prescriptions are covered and at what tier
Step 5: Check the Drug Formulary
If you take regular prescriptions, look up each medication in each plan’s formulary before enrolling. Formulary differences between plans can translate to hundreds or thousands of dollars per year in drug costs.
Step 6: Enroll Before the Deadline
For January 1 coverage, you generally need to enroll by December 15. The window stays open through January 15, but enrollments after December 15 typically start February 1 instead of January 1.
Working With a Broker
An independent broker navigates all of this for you — at no cost. Garden State Benefits helps individuals and families compare real plan costs, check networks and formularies, and enroll efficiently.
Start the conversation now so you’re ready when open enrollment opens November 1.