Choosing a health insurance plan is a major decision. Like you would with other big purchases, be sure to compare how much you will pay and the value of what you’ll get in return.
When you’re shopping for a health plan, the “price tag” you see is the monthly premium. But there are many other factors that impact your health care costs.
Factors that Impact Your Insurance and Health Care Costs
Your monthly premium is the amount you will pay to your health insurance company to keep your coverage active. But that is only the cost to buy the health plan. What will it cost you when you use your benefits, and will you have access to high-quality care?
It may seem obvious to choose the plan with the lowest premium, but a plan with a low premium may mean you have higher out-of-pocket expenses when you get care. This could cost you more in the long run if you require frequent health care.
Here are other important factors to consider in addition to the monthly premium:
Are your favorite doctors and hospitals in the network?
What services and prescription drugs are covered (or not covered)?
How much will your health insurance company pay when you get care?
How much are you responsible to pay out of your own pocket for things like doctor visits, prescription drugs, and hospital stays?
How often do you expect to use your benefits?
Does your health plan have a deductible, how high is it, and which services does it apply to?
With all these factors to consider, how can you decide which health plan works best for you?
Out-of-Pocket Health Insurance Expenses
Here are some out-of-pocket expenses (also called cost-sharing) to consider:
Copay: A copayment, or copay, is a set amount that you pay when you receive a covered health care service. For example, you may pay a $30 copay to see your primary care doctor.
Coinsurance: Coinsurance is the percentage you pay out-of-pocket for some covered services. For example, if your coinsurance for radiology services is 20%, your health insurance company pays 80% of the cost, and you pay the remaining 20%.
Deductible: Your deductible is the total amount you pay for health care services before your health insurance starts paying for some or all the costs. Every health plan has different deductibles, and deductibles may apply only to some services and not others.
There is also the out-of-pocket maximum, which is the most you will pay for covered in-network services in one plan year. Once you meet your annual out-of-pocket maximum, any in-network covered services are covered at 100%. All in-network out-of-pocket costs (i.e., copays, coinsurance, and deductibles) count toward your out-of-pocket maximum.
Does a Higher Premium Mean I Pay Less Out-of-Pocket?
The simple answer: Usually.
Be sure to look at what out-of-pocket costs you’ll pay when you receive services. You’ll also want to think about how much you anticipate using your benefits. If you expect to use health care services frequently in the plan year, you may want to pick a plan with a higher premium so you can pay less for each service. But if you are not someone who uses health care services often, it may be more affordable to choose a lower-premium plan.
Estimate Health Care Costs for an IBX Insurance Plan
You may be eligible for financial assistance in the form of a tax credit (also known as a subsidy).
There is currently some uncertainty around enhanced tax credits from the 2021 American Rescue Plan Act (ARPA). But even if these enhanced tax credits expire, financial assistance will still be available for 2026 health plans at the pre-ARPA tax credit levels. You may still qualify for a tax credit based on your updated income and household information.
Find out if you are eligible for a tax credit (subsidy) using our online ACA Subsidy Calculator.
IBX Offers Affordable Health Insurance Plan Options
Independence Blue Cross (IBX) knows Philly; we’re your hometown health insurer. And we’re the only health insurance carrier in the area that has continuously offered coverage for individuals and families since the start of the Affordable Care Act in 2013.
Our 2026 options include health plans with no deductible. Plus, no matter what IBX health plan you choose, you always have access to the full IBX provider network — the largest network of doctors and hospitals in the region.
IBX offers a wide variety of options so you can find an affordable health plan that works for your personal health, budget, and preferences. Learn more about choosing the right health plan.
Do you need help finding the right health plan? IBX is here for you! Call 1-888-475-6206 (TTY: 711) to speak to a licensed agent who can answer your questions and help you enroll.
