Find the best health insurance plan for 2015

Most people would rather not think much about health insurance. It's fiendishly complicated, and the forms can be mind-numbing. But the consequences of choosing the wrong plan can be enormous.

Open enrollment runs through Feb. 15 this year if you want to purchase coverage on your own for 2015. Here's what you need to know to make a smart choice and find the best health insurance for you and your family.

Health insurance should cover any medical need you may have, now or in the future. Medicare and Medicaid have always covered all standard types of medical care, and so have most plans available through jobs.

Buying insurance on your own used to be riskier because many plans didn't cover important things such as prescription drugs or mental health care. But now, thanks to the Affordable Care Act, those plans must cover all "essential health benefits," as they're called. And every kind of health insurance must now cover preventive care, with no deductibles, co-pays, or other types of out-of-pocket expenses. That includes Pap and cholesterol tests, mammograms, immunizations, and colonoscopies when age- and condition-appropriate.

But even though you no longer have to worry about your basic health care needs being covered, you'll still have to navigate lots of other confusing choices. That's true even if you get coverage through a job, because more than half of workers have a choice of two or more types of health plans.

And if you get your health care through a private Medicare Advantage plan, as 28 percent of all Medicare beneficiaries now do, you'll confront similar choices. Here are the most important questions to consider:

1. Do you want to pay for care now or later?

All health plans have to come up with enough money to pay for the medical expenses of their members. But there are several ways they go about this.

One is to collect most of the money up front in the form of premiums. If you have a high premium, you'll pay a smaller share out of your own pocket, in the form of deductibles, co-insurance, and co-pays. Or plans can go the other way, charging smaller premiums but asking you to pay a bigger share on your own.

Which approach is better for you depends on your personal situation and the state of your finances. If you know you will need a lot of medical care (you have a chronic condition, for example, or a houseful of accident-prone kids), you might prefer a plan with higher premiums but lower deductibles and co-pays. That will help smooth your outlays over the year. A plan with a higher deductible and more cost-sharing, on the other hand, can be a sensible choice if you are in good health and willing to bet you'll stay that way.

If you buy insurance on your own, the plans available to you, whether sold through the official online state marketplaces or not, are categorized in "metal tiers" that indicate the relative proportion of cost-sharing involved. Bronze plans pick up, on average, 60 percent of costs through premiums and the rest through out-of-pocket spending; Silver plans (the most popular) cover 70 percent; Gold, 80 percent; and Platinum, 90 percent.

Buying insurance? Here are nine ways to get your application right.  

2. Are you OK with a small network of docs?

Doctors and hospitals accept lower fees from insurers if they know they'll be part of a small, or "narrow," network, because that guarantees them a bigger share of the plan's business. There's no evidence that you'll get worse care in narrow networks. And they can save you about 20 percent over larger networks. But make sure that the plan has enough choice of doctors and hospitals in your area—a particular consideration if you live in a rural area.

If more choice is important to you, consider enrolling in a Health Main­tenance Organization (HMO) with a broader network, or a Preferred Provider Organization (PPO) or Point of Service (POS) plan, both of which allow you to go out of network. But know that PPO and POS plans generally cover a lower percentage of costs for out-­of-­network care.

The equation changes if you have a condition that requires continuing care. If you take a costly drug, for instance, your first priority should be to find a plan with generous coverage for it. If you have a trusted specialist who has been managing your chronic or serious illness, the best plan will be one that he or she participates in.

3. What if I buy insurance on my own?

You're in luck. Thanks to the Affordable Care Act, you now have access to tax credits to offset the costs of premiums and, in some cases, subsidies to help with out-of-pocket expenses. If your 2015 household income will be less than $46,680 for a single person, $62,920 for two people, $79,160 for three, or $95,400 for four, you may qualify for help.

But there's one condition: You must purchase a plan through your state's health insurance marketplace and apply for financial aid on that marketplace. If you buy an "off-­market­place" plan, you can't get that assistance.

The most surefire way of doing that is to access your state's marketplace. Start at HealthCare.gov. The marketplaces offer free in-person or phone help if you're confused. You can also consult an independent broker, but if you do that, emphasize that you need to go through your state marketplace and want to apply for financial help.

The off-marketplace plans are legitimate health insurance plans that will fulfill your legal obligation to have coverage. But once you've bought a non-marketplace plan for 2015, you can't switch to another one until 2016 and can't claim a subsidy even if your income drops midyear.