PEOPLE WHO BUY health insurance often
have difficulty comparing health plans with
different benefits and out-of-pocket costs. In
addition, it can be difficult to know the benefits
and costs of services included in your health
plan. Under the Affordable Care Act, plans
offered in the individual and small-business
marketplace are standardized by the types of
benefits and cost-sharing they
offer, making it easier for consumers to know what is covered and how much services
will cost. Here’s a primer.
Marketplace insurance
plan categories
Marketplace insurance plans
are classified in four categories:
bronze, silver, gold and platinum.
All categories offer the same set
of essential health benefits: ambulatory patient services; emergency
services; hospitalization; maternity and newborn care; mental
health and substance abuse disorder services; prescription drugs; rehabilitation
and habilitation services and devices; lab services; chronic disease management; and pediatric services, including oral and vision care.
These benefits must all be paid for, to some
extent, by the insurance company after you
meet your deductible. Also, preventive ser-
vices such as annual physicals, cholesterol
tests, mammograms and colonoscopies
must be covered free of charge.
The difference between these plan categories is the cost of your monthly premium and what portion of the bill you pay
for, such as hospital visits and prescription
medications. The categories
help you choose a plan that’s
right for you.
Bronze. Bronze plans
have the lowest monthly
premiums but only cover an
average of 60 percent of
incurred medical bills. The
policyholder is responsible
for roughly 40 percent of non-preventive health-care costs.
Bronze plans are a good option for
people who require little to no
medical care in an average year.
Silver. Silver plans have
slightly higher premiums than
bronze plans and cover an aver-
age of 70 percent of annual non-preventive
health-care costs, with the policyholder
paying the remaining 30 percent. People
who choose silver plans and earn an
income of up to 250 percent of the federal
poverty level are eligible for reduced out-
of-pocket costs. Silver plans are also used as
the basis for determining health insurance tax
subsidies for people with an income of up to
400 percent of the federal poverty level.
Gold. Gold plans cover an average of 80
percent of medical care, with the policy-
holder paying the remaining 20 percent.
People with gold plans pay higher premiums
than people with bronze or silver plans.
Platinum. Platinum plans have the highest premiums and also the most coverage,
with an average of 90 percent of medical care
paid for by the insurance company. Gold and
platinum plans are the best options for people who are likely to require a lot of medical
services in any given year.
In general, 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.
Catastrophic plans
People under 30 and some people with a
limited income may purchase what is called a
When you fill out a Marketplace application, you’ll see catastrophic plans listed as
an option if you qualify. If you don’t qualify
for a catastrophic plan, you will not see it as
an option. C
Connecting
You can learn more about available health
plans in your area with help from the Costco
Health Insurance Marketplace. Just go to
Costco.com and click “Services,” then “Costco
Health Insurance Marketplace,” to review
plan rates and details, and check to see if
you qualify for a reduced rate as a result of
health-care reform. If you have questions,
a licensed representative from the Costco
Health Insurance Marketplace can assist you.
Costco also offers health, dental and
vision plans and business presciption insur-
ance for small businesses and personal life
insurance, dental and vision plans for indi-
viduals. Go to Costco.com and click “Services.”
To market,
to market
Navigating the Affordable
Care Act Marketplace
atric services, including oral and vision care.
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