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Health Care Reform:

Health Insurance & Affordable Care Act

Your Insurance Choices in a Marketplace: FAQ

A health insurance  Marketplace, also known as an Exchange, is a web site where you can shop for and compare  insurance plans in your state. Your state's Marketplace has tools to make it easy for you to compare your choices and pick the best for your needs.

On a state Marketplace site, health plans are grouped by levels of coverage -- how much the plan will pay for your health care and what services are covered.

Each level is named after a type of metal:

Bronze plans offer the least coverage and platinum plans offer the most.

How do the bronze, silver, gold, and platinum levels differ?

The metal plans vary by the percentage of costs you have to pay on average toward the health care you receive.

Here are the percentages of health care costs you pay for each type of plan:

  • Bronze plan: 40%
  • Silver plan: 30%
  • Gold plan:  20%
  • Platinum plan: 10% of your health care costs.

The way you pay your portion of these costs is in deductibles and copayments or co-insurance.

In general, the more you are willing and able to pay each time for health care service or a prescription, the lower your premium. A premium is your monthly payment to have insurance.

As an example, when you compare the bronze and platinum plans:

With a bronze plan: You pay the most each time you see your doctor or get a medicine. This is also called having higher "out-of-pocket" costs. But in a bronze plan you pay the least premium each month.

With a platinum plan: You pay the least each time you see your doctor or get a medicine. But in a platinum plan you pay the highest premium each month.

How does coverage from a metal plan compare to my current insurance?

The bronze through platinum coverage levels are new. So you probably don't know how the benefits of the plan you use today compare to them. The coverage level you have now depends on whether you bought your plan:

  • From an employer: Your coverage level is likely between a gold and platinum level.
  • On your own: Your coverage level is likely between a bronze and silver level.

Having a sense of how the insurance you're used to compares with the new plans will help you decide on a plan. You should compare the out-of pocket costs you are currently paying, the services provided (including prescription drugs), and anticipated changes in your health. 

If you shop for insurance on your state's Marketplace, you'll see the health plans organized in this way:

  • 1st by metal level: Bronze, silver, gold, or platinum
  • 2nd by brand, such as Blue Cross, Cigna, Humana, Kaiser, United, and others
  • 3rd by type of health plan, such as HMO, PPO, POS, or high-deductible plans with a health savings account.

The type of health plan affects how much choice you have in providers, the amount of paperwork you have, and your out-of-pocket costs.

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