Related imageAs you are aware, marketplace open enrollment began on November 1st and is due to close on December 15th.  With open enrollment you can renew your current plan or choose a new one.  Signing up for insurance in marketplace has become easier but choosing a health plan right for you can be complicated.  The following information and terms can help you better understand each health plan category and networks,  

The 4 “Metal” Health Plan Categories

These categories are based on how you and your plan will split your health care costs not quality of care.

  • Bronze category usually has the lowest monthly premium.  But paying your medical costs out of pocket before your insurance plan starts are extremely high. The ratio for the Bronze category is 60% paid by your insurance company and 40% paid by you.
  • Silver category has moderate monthly premiums and deductibles, the cost you pay out of pocket before your plan pays anything, is usually lower than a Bronze health plan.  The ratio for the Silver category is 70% paid by your insurance company and 30% paid by you.
  • Gold category has high monthly premiums with a deductible that is usually low.  This plan is a good choice if you are willing to pay more each month to have more costs covered when getting medical treatment, especially if you require a lot of care.  The ratio for the Gold category is 80% paid by your insurance company and 20% paid by you.
  • Platinum category is usually the one with the highest monthly premium and deductibles are very low.  This plan starts paying its share earlier than other plans and is a good choice if you require more care than usual.  The ratio for the Platinum category is 90% paid by your insurance company and 10% paid by you.

Premium, Deductible and Out-of-pocket costs

You will have to pay your insurance company a monthly bill known as a premium, even if you did not use any medical services that month.  When choosing a health plan, it may be a good idea to look at your total health care cost and not just the monthly payment.

  • A deductible is how much you must spend for covered health services before your insurance company.
  • Copayments and coinsurance are payments you make each time you get a medical service after reaching your deductible. 
  • An out-of-pocket maximum is the most you must spends for covered services in a year.  After this amount is reached, the insurance company pays 100% for covered services.

Types of Marketplace Health Plans

  • Exclusive Provider Organization (EPO) is a managed care plan that covers services only if you use doctors, specialists, or hospitals in the plan’s network.
  • Health Maintenance Organization (HMO) is a type of plan that usually limits coverage to care from doctors who work with the HMO.  An HMO may require you to live or work in its service area to be eligible for coverage and will not cover out-of-network care.
  • Point of Service (POS) is 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.  These POS plans require a referral from your primary care doctor in order to see a specialist.
  • Preferred Provider Organization (PPO) is a type of health plan where you pay less if you use providers in the plan’s network.  For an additional cost, you can use doctors, hospitals, and providers outside of the network without a referral.
Contact our offices to get you started on your new health plan or to answer any of your questions