Your Coverage & Care
Your Coverage & Care
 
Understanding Health Coverage

Health Exchange Marketplace Plans

These plans are federally regulated as governed by the Affordable Care Act. However, they are administered by a private insurer (e.g., Blue Cross Blue Shield). These plans are for individuals who:

  • are self-employed
  • work for a company that offers no or limited health coverage
  • are unemployed 
  • have historically purchased an individual coverage directly from a private insurer 

The health care law provides important protections for all health care consumers and all Marketplace plans cover the same essential benefits.

The Marketplace offers plans at four levels (Bronze, Gold, Silver and Platinum). They are cost-sharing plans. For example, you may be responsible for 30% of all costs and the insurer covers the remaining 70% after you reach your deductible. Depending on your income and other factors, you may qualify for a tax credit that will help to cover most of your premium. Get more details about these plans and the tax credit at www.healthcare.gov.

You can sign up on your state’s website or on healthcare.gov during open enrollment or if you have a special qualifying event. You can also apply by phone in two ways:

  • call the Marketplace Call Center at 1-800-318-2596
  • get help from a trained assister in your community. 

After answering a few questions, you’ll be able to see your health plan options with estimated prices based on your income. You can check if you qualify for savings. Use this checklist to make sure you have the information you need to start an application and learn about important dates related to coverage.

You won’t be able sign up outside of open enrollment without qualifying for a special qualifying event, like moving, having or adopting a child, losing other health coverage, or getting married.

Depending on the insurer providing the coverage, any level can offer an HMO, PPO, POS or EPO option. For example, you can get a Bronze HMO, Bronze PPO or Bronze POS plan. Similar to commercial and employer plans, you will need to also purchase stand-alone dental and vision coverage.

People with arthritis should carefully review plan options that offer greater coverage and moderate to lower out-of-pockets costs due to the need for ongoing care to manage their disease. Even if you feel comfortable signing up online, you may consider discussing your options with a trained Healthcare Marketplace agent before you enroll.

Here is an overview of the plan types:

Bronze

  • Lowest monthly premium.
  • Highest costs when you need care. 
  • Deductibles can be thousands of dollars a year. 
  • You pay for most routine care.

Silver

  • Lower deductibles than Bronze plans.
  • Moderate monthly premium and out-of-pocket costs when you need care.
  • If you get a Silver plan, you can qualify for extra savings, based on your income. These discounts can help reduce how you pay out of your own pocket each time you get medical services.

Gold

  • High monthly premium.
  • Low costs when you need care and deductibles are usually low.
  • You’ll pay more each month but more costs will be covered when you get medical treatment. So it may be a good value, if you use a lot of care.

Platinum

  • Highest monthly premium.
  • Lowest costs when you get care.
  • Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
  • If you’re willing to pay a high monthly premium, and usually use a lot of care, knowing nearly all other costs will be covered is a plus.
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