After answering the questions on the Health Insurance Marketplace website, your next step is to choose a plan that makes sense for you and your family. But with so many different plan types, coverage levels, and insurance costs to consider, reviewing the options on your screen can be confusing.
Understanding the fundamentals behind all available plans will make it easier to find one that fits your needs. Here is how to review the health insurance plans available through the Marketplace.
1. Understand the Five Plan Categories
All Marketplace health plans fall under one of five different categories. The category determines what percentage of costs the plan pays of the average overall cost of providing essential health benefits to members. These are the five categories:
- Bronze: With these plans, providers pay around 60% of costs; you pay the remaining 40%.
- Silver: Silver plans offer a 70/30 percent split between provider/member cost responsibilities.
- Gold: These provide an 80/20 percent provider/member cost split.
- Platinum: These provide a 90/10 percent provider/member cost split
- Catastrophic: Only available to those under 30 or who have special exemptions, people with Catastrophic plans are responsible for more than 40% of the total cost of care. Note that by choosing a Catastrophic plan, you also waive your subsidy, assuming you’re otherwise eligible.
Generally speaking, the more precious the metal the plan is named after, the higher your monthly premium will be. Use these categories as a guide to understanding the percentage of costs for which you’re responsible – not the costs themselves. Actual costs for each plan are determined by cost types.
2. Understand the Three Types of Costs
Now that you understand how plan categories relate to provider/member cost responsibilities, let’s look at the three types of costs you should consider for each policy that falls within your budget:
- Premium: Perhaps the most obvious and well-understood of health plan costs, is what you pay each month to maintain coverage. It may be tempting to base your purchasing decision on the monthly premium alone, but you really shouldn’t neglect…
- Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay.
- Out-of-pocket maximums The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits.
Note the difference between deductibles and out-of-pocket maximums. Many plans will offer comparable deductibles and out-of-pocket maximums, but not all of them!
3. Compare Coverage Details
While all Marketplace plans offer the same health benefits defined as essential health benefits by the Affordable Care Act (ACA), some plans offer additional benefits on top of what the law stipulates. After you’ve identified plans that fit your needs in terms of provider/member cost split, premium payments, and deductible/out-of-pocket concerns, dig deeper into each plan. You might find one that provides more benefits for comparable costs.
4. Identify Additional Cost-Saving Opportunities
In some cases, Marketplace coverage may offer more savings opportunities than meet the eye. In addition to subsidy eligibility, your income could qualify you for a cost-sharing reduction plan, which would allow you to enjoy Silver-level coverage for out-of-pocket costs comparable to those for Bronze plans. And if you’re under 30 and figure a Catastrophic plan is undoubtedly your least expensive option, think again. Depending on your subsidy eligibility, a Bronze plan might be even more affordable.
Navigating Marketplace health plan options can be confusing. HealthMarkets Insurance Agency can help you sift through the gritty details and discover the best, most affordable option for you – and we won’t charge you a dime. Call (800) 827-9990 now to get started!