Taking Control of Your Coverage: How to Make the Most of Your Health Insurance Plan in 2026
James Grant, M.D.
| 4 min read
James D. Grant, M.D., is executive vice president an...
Key Takeaways
- ACA Marketplace plans are available in four metal levels: the higher the metal level, the lower the deductible and the share of covered costs for the member.
- Individuals with high-deductible health plans may be eligible for health savings accounts, which are tax-advantaged accounts.
- Be aware of which providers are included in your plan’s provider network. Sometimes, members will need to switch to a different primary care or specialist provider if their former providers do not participate in the new network.
- All health plans sold on the ACA Marketplace include a comprehensive set of preventive care benefits available at no cost.
Roughly 200,000 people who purchase their own health insurance from Michigan’s ACA Marketplace were transitioned to different plans for 2026 because their original health plans were discontinued as insurers pulled out of the market.
Some may have selected new plans that are very similar to their old ones, while others may have selected a different type or level of coverage. Either way, it’s important for individuals to understand the benefits included in their plan, and how to use them.
Here is a refresher on different plan features and how to take advantage of the benefits.
What to know about out-of-pocket expenses
ACA Marketplace plans are available in four categories, or metal levels: bronze, silver, gold and platinum. The higher the metal level, the lower the deductible and the share of covered costs for the member. However, monthly premiums are also higher as the metal level rises.
For example, in a Bronze level plan, the insurer pays 60% of covered costs and the member pays 40% after the deductible is met. The deductible is high.
Comparatively, in a Platinum level plan, the insurer pays 90% of covered costs and the member pays 10% after the deductible is met. The deductible is on the lower end, but the premium is higher.
Members should familiarize themselves with what their out-of-pocket responsibilities will be in their new plan, so they can plan ahead for potential expenses.
What do I need to know about an HSA?
Individuals who have high-deductible health plans may be eligible for health savings accounts (HSA), which are tax-advantaged accounts that allow members to put money aside specifically for qualified health expenses.
In 2026, a plan is considered to have a high deductible when it is at least $1,700 for an individual or $3,400 for a family.
Because HSAs are tax deductible, there are limits on how much can be contributed into the account per year. In 2026, that limit is $4,400 for individual coverage and $8,750 for family coverage. Those aged 55 and older can contribute an additional $1,000 per year.
There are several tax advantages to HSAs – contributions are tax-deductible, and there are no taxes on the fund growth or the withdrawals for qualified medical expenses. It’s a great way to put money aside to help cover out-of-pocket expenses.
What is a provider network?
Be aware of which providers are included in the plan’s provider network. Sometimes, members will need to switch to a different primary care or specialist provider if their former providers do not participate in the new network.
In most Preferred Provider Organization (PPO) health plans, individuals pay less out of pocket when they use an in-network provider or facility. Typically, in Health Maintenance Organization (HMO) health plans, members are responsible for all the cost if they get care from a provider or facility that is out of network.
Members should also be aware of policies surrounding procedures and specialist providers. For example, in an HMO plan, members will need to get a referral from their primary care provider to see a specialist provider, and many procedures and services require preauthorization.
In most PPOs, members can see specialists without getting a referral, but some procedures and services may require preauthorization. Members who are aware of these policies can save themselves time and be better prepared for expenses.
What is prevention and why is it important?
All health plans sold on the ACA Marketplace include a comprehensive set of preventive care benefits available at no cost to members when received from an in-network health care provider.
For example, members can start off the new year by making an appointment for an annual health exam. Many immunizations are covered, as well as health screenings such as diabetes, cholesterol, blood pressure and depression.
Whether or not individuals have a new health plan this year, it’s always a good idea to familiarize themselves with the benefits provided in their plan, and the policies and procedures surrounding plan use. This enables members to get the most out of their plan while taking care of their health.
James Grant is the Chief Medical Officer at Blue Cross Blue Shield of Michigan. For more health tips and information, visit MIBlueDaily.com.
Photo credit: Getty Images
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