My comments: This is a great summary of what the overview of the plan structure is going to look like. This is where it’s important to note affordable premium does not equal affordable care. For example, the Bronze program has a lower premium but a 60/40 co-insurance. For those of us use to a standard 80/20 or even 90/10 – 60/40 on a major illness takes my breath away and would probably devastate the finances of most families.
There are 4 categories of Marketplace insurance plans: Bronze, Silver, Gold, and Platinum. The categories help you choose a plan that’s right for you.
4 categories of Marketplace insurance plans
When you compare Marketplace insurance plans, they’re put into 4 categories based on how you and the plan can expect to share the costs of care:
All Marketplace insurance plan categories offer the same set of essential health benefits.The categories do not reflect the quality or amount of care the plans provide.
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs —the total amount you’ll spend for the year if you need lots of care.
Balancing monthly premiums with out-of-pocket costs
As with all health plans, you’ll have to pay a monthly premium. But it’s also important to know how much you have to pay out-of-pocket for services when you get care.
Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold plan, you’ll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
With a Bronze plan, you’ll likely pay a lower premium, but you’ll pay a higher share of costs when you get care.
Platinum plans will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care.
In general, when choosing your health plan, keep this 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.
What to consider when choosing your plan
Think about the health care needs of your household when considering which Marketplace insurance plan to buy.
Do you expect a lot of doctor visits or need regular prescriptions?
If you do, you may want a Gold or Platinum plan.
If you don’t, you may prefer a Bronze or Silver plan. But keep in mind that if you get in a serious accident or have an unexpected health problem, Bronze and Silver plans will require you to pay more of the costs.