Healthcare Insurance
Affordable Care Act (ACA)
Thanks to the Affordable Care Act, millions more Americans have gained health coverage without limits, and protections are in place for people with preexisting conditions. People have access to essential health benefits, including preventive and rehabilitative care, prescription drugs, wellness visits and contraceptives, mental health and substance use treatment, among many others
​​​​
​The amount you pay for your health insurance may depend on where you live, your income, and the size of your household. Health insurance costs include a premium, which is what you pay for your insurance plan each month. But, if you seek health care services, you may also have to pay out-of-pocket costs.
​
Health insurance plan & network types: HMOs, PPOs, & more
There are different types of Marketplace health insurance plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network.
​​​​
Types of Marketplace Networks
Some examples of plan types you’ll find in the Marketplace:
-
Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
-
Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
-
Point of Service (POS): 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. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
-
Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
ACA Health plan categories: Platinum, Gold, Silver, & Bronze
Marketplace plans are put into 4 categories (or "metal levels"): Bronze, Silver, Gold, and Platinum. Catastrophic plans are a 5th category available to people under 30 and some people with limited incomes.
The categories have nothing to do with the quality of care you get in a plan. Generally, the difference between categories is based on the plan's share and your share of costs for covered services. If you qualify for extra savings (based on your income) and enroll in a Silver plan, the plan pays more and you pay less.
​​​​​
​​
How do YOU pick a plan category?
When you shop for a Marketplace plan, think about:
​
-
Your total spending on health care, not just the
premium
. Review plans in different categories to see how the plan's share of costs can adjust the estimate for your total yearly costs. Get more details to estimate your total yearly costs.
-
Enroll in a Silver plan if you qualify for extra savings. You'll find out if you qualify for "extra savings" when you apply for a Marketplace plan. You only get the extra savings if you enroll in a Silver plan.
-
The premium tax credit. You'll also find out if you qualify for a premium tax credit when you apply for a Marketplace plan. If you qualify, you can get lower premium costs in any metal plan category.
-
Coverage. All Marketplace plans in every plan category must cover the same 10 essential health benefits, including preventive services. Many plans also offer programs that help manage chronic diseases and health conditions before you meet your deductible. Discover what Marketplace plans cover.
-
Quality of care. Compare each plan's quality with their quality rating, a star rating on a scale of 1-5. The name of a plan category has nothing to do with its quality of care.