How the Health Insurance Marketplace Works: Four Coverage Levels

The Affordable Care Act (or health care reform law) is creating a new way for people to get health coverage. It’s called the health insurance marketplace (or exchanges), and people can start signing up in October 2013 for plans that start in January 2014. People can go online to compare and buy health insurance.

They can choose from more than one insurance company on the marketplace and look at plans that offer a core set of benefits, called “essential health benefits.” These benefits include coverage for emergency room care, hospital stays, maternity and newborn care, prescription drugs and preventive care. Copayments, coinsurance and deductibles will still be part of most plans.

Four Levels of Coverage

The health care marketplace will offer four levels of coverage: bronze, silver, gold and platinum. Each insurer designs the benefit plans it chooses to offer in each category. All must meet certain rules, like covering essential health benefits. In the health insurance marketplace, each level may have a few plans to choose from, with bronze having the lowest monthly premium, but higher out-of-pocket costs for care. Platinum plans have the highest monthly premium, but lower out-of-pocket-costs for care. The categories do not reflect the quality of care the plans provide. They simply tell us the percent of costs the plan pays.

  • Platinum – 90% coverage
  • Gold – 80% coverage
  • Silver – 70% coverage
  • Bronze – 60% coverage

People will choose a level of coverage based on their budgets and health care needs. Coverage levels impact how much their premium costs each month and how much they pay for things like hospital visits or prescription drugs.

Beyond the essential health benefits, different plans may offer coverage for different services. For example, plans offered at the bronze level will not all be the same. They will be from different companies and may cover different services at different costs. Provider networks will also vary.

That’s why we’re here - to guide and assist you in choosing the most appropriate plan for your needs.

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Eve Brosnahan

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