Health insurance is an incredibly important part of accessing healthcare. Without insurance, the cost of medical care can sway you from seeking medical treatment early on and cause you to delay being seen until the condition is so bad you may need to be seen in the ER. Preventive medicine and early treatment allow for better health outcomes, less sick days at work, less chronic conditions, and being able to live your daily life to the best of your abilities.
In 2010, former President Barack Obama signed into law the Patient Protection and Affordable Care Act (often shortened down to the Affordable Care Act or the ACA), which sets up new rules and regulations that insurance companies needed to abide by to comply with the federal statute. The ACA’s website, Healthcare.gov, launched in October 2013. Though there were some initial problems with the site, it eventually got off the ground and is now working well, providing information on plans and enrollment to interested consumers.
Before picking a health insurance plan, there are some things you should know so that you can navigate the website successfully and select the best plan for your needs.
Firstly, understand that when it comes to health plans there is no “one size fits all” motto. In fact, there are four different overall categories of plans from which to choose: bronze, silver, gold, and platinum, all of which will be discussed in the sections below. The plan you select has nothing to do with care quality, you will still receive great services, instead, it relates to how much you will pay for your care.
Secondly, you should know that even if you do not use healthcare services during the month, you will still need to pay a premium. With the ACA, you still pay deductibles and out-of-pocket costs. How much you estimate that you will need in care is a factor when choosing a plan.
Lastly, be aware that in addition to the four “metal” categories stated above, there are also different types of plans including HMO, PPO, EPO, and POS that affect the doctor you see and the price you pay.
Metal Categories:
- Bronze: The “bronze” plan has the lowest monthly premium. The insurance company pays 60% of your care costs, while you pay 40% out-of-pocket. The bronze plan, while it still provides high-quality care, costs more out-of-pocket than the other three. The deductible on the bronze plan can reach thousands per year depending on the type of year you have health-wise. The bronze plan is a good idea for those of us who are fine paying for routine care and don’t have a lot of medical issues if any. The bronze plan provides protection against serious medical ailments, sicknesses, and injuries that can strike unexpectedly. However, when it comes to routine care and appointments, you will pay out-of-pocket for a decent-sized portion of that care.
- Silver: The silver plan has a moderate monthly premium, meaning that it is more expensive than the bronze plan but less expensive than gold and silver. With the silver plan, the insurance company pays 70% of your care costs and you pay the other 30% out-of-pocket. If you qualify for “extra savings,” you must pick the silver plan to receive these extra savings. Qualifying for “extra savings” means that you get a discount that allows for a cost-sharing reduction. When you apply for health care in the marketplace, you will receive an Eligibility Determination Notice. In that notice, you will be notified if you qualify for the income-based cost-sharing reduction. If you qualify, you must pick the silver plan to receive this reduction. The silver plan is great for those who qualify for extra savings, but, even if they don’t, it is also a viable option for those who want more of their routine care covered than would be on the bronze plan.
- Gold: With the gold plan, you have a high monthly premium, but, when you need care, you have low out of pocket costs. Insurance pays for 80% of your care expenses, while you pay the other 20%. The deductible on this plan is usually very low. If you use a lot of healthcare, the gold plan is a good option because it will cover a large amount of routine care, as well as other medical treatments. It may end up saving you money in the long run, as opposed to repeatedly paying out-of-pocket costs.
- Platinum: The platinum plan has the highest monthly premium costs out of all the metal categories. This plan provides you with the lowest costs when you do need care, as insurance pays 90% and you only pay 10%. If you are someone who needs a lot of medical care each month, this plan may be the most advantageous for you to select. If you are willing to pay a high premium, while knowing that almost all your other costs will be covered, then this is a good choice.
While these plans don’t skimp on the quality of care, the main difference is the costs you incur as a result of your choice. Depending on your personal finances and the level of care you need each month, plans with high premium and low care costs (or vice versa) could be your best bet to receive affordable care.
