A health insurance plan is only useful if it works with the care you need. Before choosing an ACA Marketplace plan, check both provider access and prescription coverage.

Confirm your doctors

Search the insurer’s current provider directory and contact the doctor’s office to confirm participation in the exact plan. Networks can differ between plans from the same insurer.

Check hospitals and specialists

If you have a preferred hospital or specialist, confirm whether they are in network. Review referral rules and whether out-of-network care is covered.

Review your prescriptions

Check each medication against the plan’s formulary. Look for tier placement, prior authorization, step therapy, quantity limits, and preferred pharmacy requirements.

Compare the full cost

Consider premiums, deductibles, copayments, coinsurance, and the out-of-pocket maximum. Check whether services you commonly use are subject to the deductible.

Keep proof of your checks

Save the plan name and date of verification. Provider directories can change, so reconfirm important details before enrolling and before receiving care.

Important: Provider networks and formularies can change. Verify details with the insurer and read the plan documents before making a decision.