Buying health insurance for the first time

Are you buying health insurance for the first time? Are you wondering where to start? You are in the right place! Use this simple guide to help you understand the basics so you can find the perfect plan. If you start to feel overwhelmed, remember that buying health insurance for the first time can be challenging. Keep coming back to this guide to help you through the process.

How to buy health insurance for the first time

If you’re buying health insurance for the first time, a little preparation can make the process easier. Start by gathering some basic information and considering these key factors before comparing plans.

Before you start shopping, make a list of:

• Providers and hospitals you want to use.
• How often you typically receive medical care.
• Prescription medications you take.
• What you can comfortably spend on healthcare each month.
• Any healthcare services you expect to need in the coming year.

Ready to start comparing your options? Learn more about how to compare plans and what to look for when buying health insurance.

Do you already have doctors or hospitals you trust?

• Yes: Use our provider search tool to determine whether your trusted doctors and hospitals participate in the networks of the plans you’re considering.
• No: Make a list of providers or types of providers that you would like to see. Use our provider search tool to help you determine which networks those doctors and hospitals are in.

How often do you expect to need medical care?

• A lot: Consider a plan with a higher monthly premium and a lower deductible. With this type of plan, you won’t have to worry about high out-of-pocket costs each time you visit a provider.
• A little: If you don’t think you’ll use your health insurance that much, you may want to consider a plan with a low monthly premium and a higher deductible. But remember that your coverage needs can unexpectedly change. Make sure you're prepared for whatever life brings.

Do you take any prescription medications?

• Yes: Make sure they are included in our formulary (a list of prescription drugs that are covered by a plan). Note whether there are any special limits or coverage requirements.
• No: It’s still a good idea to review the formulary of any plan you consider. You’ll want to make sure you understand which drugs your plan will cover and how commonly they are prescribed.

Understanding common health insurance terms

If this is your first time buying health insurance, these key terms can help you understand how coverage works and what to look for in a plan:

• Premium: This is the amount you must pay to maintain an insurance policy. It is often paid in monthly installments.
• Deductible: This is the amount you owe for covered health services before your health plan begins to pay. The deductible may not apply to all services.
• Copayment: This is a fixed fee that you must pay for a covered healthcare service, usually at the time you receive the service. Copayments vary by the type of service you receive.
• Coinsurance: This is the percentage of the cost of your healthcare services that you must pay after you’ve met your deductible. .
• Out-of-pocket limit or maximum: This is the most you will pay during a policy period (usually a year) before your health insurance or plan will pay 100 percent of the cost of your covered services. Your out-of-pocket maximum never includes your premium, balance-billed charges, or healthcare that your health insurance or plan doesn’t cover.

Why choose UPMC Health Plan?

At UPMC Health Plan, we support our members in focusing on their total well-being.  We want to make sure you have everything you need to be as healthy as possible. We do this by providing:

• A broad provider networkwith access to top-ranked doctors and hospitals and an extended network.¹
• Digital resources to support your total well-being and the UPMC Health Plan app for easy access to your health insurance information.
• Telehealth services, including behavioral health support and health coaching.
• Preventive care benefits—including $0 preventive care that covers many health services for adults and children at 100 percent—and coverage for high-value generic and no-cost preventive medications.^2,3
• Local support from our exceptional Health Care Concierge team for help navigating your benefits with a quick online chat or phone call.
  

Understanding the different metallic levels

When you are shopping on the marketplace for health insurance coverage, you’ll notice that plans are grouped into three categories: Bronze, Silver, and Gold. These metallic categories represent the levels of coverage that plans provide, on average, over time. Generally, low-coverage plans (Bronze) have low monthly premiums and higher out-of-pocket costs. High-coverage plans (Gold) have higher monthly premiums and low out-of-pocket costs.

Here’s a look at how the metallic levels typically work:

Gold plans cover 80 percent of costs.

Silver plans cover 70 percent of costs.

Bronze plans cover 60 percent of costs.

You will be responsible for paying the remaining percentage for your covered healthcare services. Here’s an example based on these cost-sharing percentages:

You select a Silver-level plan and receive care that costs $1,000. Typically, your plan will cover $700 of the cost, and you must pay $300 out-of-pocket.

Start shopping on our Marketplace

¹Go to upmchealthplan.com/best for award information. For network access details, visit upmchp.us/networkaccess.

²Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost

share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

³Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria

in accordance with the Patient Protection and Affordable Care Act of 2010.