Health Insurance

• The 4 “metal” categories: There are 3 categories of health insurance plans: Bronze, Silver, and Gold.These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.

• Your total costs for health care: You pay a monthly bill to your insurance company (a "premium"), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.

• Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.

 

Which metal category is right for you?

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Bronze

• Lowest monthly premium

• Highest costs when you need care

• Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.

• Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.

Silver

• Moderate monthly premium

• Moderate costs when you need care

• Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.

       IMPORTANT: If you qualify for cost-sharing reductions you must pick a Silver plan to get the             extra savings. You can save hundreds or even thousands of dollars per year if you use a lot of         care.

• Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.

Gold

• High monthly premium

• Low costs when you need care

• Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.

• Good choice if: You’re 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 plan could be a good value.

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Your premium can be lower, based on your income

No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income.

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Types of Marketplace plans

Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, and Platinum.

Some examples of plan types you’ll find in the Marketplace:

• Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

• Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

• Point of Service (POS): A type 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 require you to get a referral from your primary care doctor in order to see a specialist.

• Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.