Picking a health insurance plan can be complicated. Knowing just a few things before you compare health insurance plans can make it simpler.
Plans in the Marketplace are presented in 4 “metal” classes: Bronze, Silver, Gold, and Platinum. (“Catastrophic” plans are also available to some individuals.)
Some categories of health insurance plans include Bronze, Platinum, Gold, and Silver.
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles — the amount of medical expenses you pay yourself before your insurance plan starts to pay — can be thousands of dollars per annum.
- Good option if: You want a low-cost way to protect yourself from worst-case medical scenarios, such as serious sickness or injury. Your monthly premium will be low, but you will have to pay for most routine care yourself.
- Moderate monthly premium
- Moderate costs when you require care
- Silver deductibles — the costs you pay yourself before your plan pays anything — are typically lower than those of Bronze plans.
- Good option if You qualify for “extra savings” — or, if not, if you are willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
- High monthly premium
- Low costs when you require care
- Deductibles — the amount of medical costs you pay yourself before your plan pays — are typically low.
- Good option if: You are willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold health insurance plan could be a good value.
- Highest monthly premium
- Lowest charges when you get care
- Deductibles are very low, meaning your plan begins paying its share earlier than for other categories of plans.
- Good option if You usually use a lot of care and are willing to pay a high monthly premium, knowing almost all additional costs will be covered.
Your Total Costs for Health Care Services
When selecting a plan, it’s a good idea to think about your total healthcare costs, not just the bill (the “premium”) you pay to your insurance carrier every month.
You should consider your total healthcare costs when choosing a plan.
Other amounts, sometimes known as “out-of-pocket” costs, greatly impact your total spending on health care – sometimes more than the premium itself.
- Deductible: How much you have to spend for covered health services before your insurance carrier pays anything (apart from free preventive services)
- Copayments and coinsurance: Payments you make each time you get a medical service after attaining your deductible
- Out-of-pocket maximum: The most you have to spend for insured services in a year. After you reach this amount, the insurance carrier pays 100% for covered services.
Health Insurance Plan and Network Types
There are different types of Marketplace health insurance plans intended to meet different needs. Some forms of plans restrict your provider options or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of charges for providers outside the plan’s network.
Types of Marketplace Health Insurance Plans
Depending on how many plans are provided in your area, you may find plans for all of these types at each metal level – Bronze, Silver, Gold, and Platinum.
Some examples of plan types you will find in the Marketplace:
- Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use physicians, specialists, or hospitals in the plan’s network (except in an emergency).
- Health Maintenance Organization (HMO): A form of health insurance plan that typically limits coverage to care from doctors who work for or contract with the HMO. It usually won’t cover out-of-network care except in an emergency. An HMO may necessitate you to live or work in its service area to be eligible for coverage. HMOs often offer integrated care and focus on prevention and wellness.
- Point of Service (POS): A kind of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans necessitate you to get a referral from your primary care doctor to see a specialist.
- Preferred Provider Organization (PPO): A kind of health plan where you pay less if you use providers in the plan’s network. You can use physicians, hospitals, and providers outside of the network without a referral for an additional cost.
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