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Understanding MarketPlace Plan and Coverage Options

Friday, September 27, 2013

What types of plans will be available?

There are four categories of Marketplace insurance plans:

  1. Bronze
  2. Silver
  3. Gold
  4. Platinum

Catastrophic plans available to people under 30 and those with very low incomes

What do the plans cover?

All plans will cover a comprehensive package of items and services known as essential health benefits:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs;
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

How will I know which plan is right for me?

  • Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you get care.
    • If you have a Platinum plan, you’ll likely pay a higher premium and have lower costs when you go to the doctor.
  • When choosing your health plan, keep these general rules in mind:
    • The lower the premium, the higher the out-of-pocket costs when you need care.
    • The higher the premium, the lower the out-of-pocket costs when you need care.
  • Do you need regular prescriptions or expect a lot of doctor visits?
    • If so, then you may want a Platinum or Gold plan.
    • If you don’t, you may prefer a Silver or Bronze plan.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.

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