OBAMACARE

Health insurance is essential to maintaining medical health, but also to keep any potential medical expenses manageable. The consequences of a medical emergency without health insurance could extend far beyond your immediate finances to loss of income and possibly bankruptcy.

All plans offered in the Marketplace cover these 10 essential health benefits:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)

• Emergency services

• Hospitalization (like surgery and overnight stays)

• Pregnancy, maternity, and newborn care (both before and after birth)

• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

• Prescription drugs

• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

• Laboratory services

• Preventive and wellness services and chronic disease management

• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

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.
When you fill out a Marketplace insurance application, you’ll find out if you qualify for these savings.

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.

How you and your insurance plan split costs

Estimated averages for a typical population. Your costs will vary.

Which metal category is right for you?

No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income. When you fill out a Marketplace insurance application, you’ll find out if you qualify for these savings.

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.

Silver

• Moderate monthly premium

• Moderate costs when you need care

Silver plan 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.

Gold

• High monthly premium

• Low costs when you need care

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

Platinum

• Highest monthly premium

• Lowest costs when you get care

Platinum plan deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.

Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible.