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Health Care Reform:

Health Insurance & Affordable Care Act

Your Insurance Choices in a Marketplace: FAQ

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

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 which doctors and hospitals are in your plan), 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 can affect how much choice you have in providers and your out-of-pocket costs.

I've heard all the health plans in a Marketplace have to cover the same essential benefits. So what's the difference between the plans?

All health plans have to provide certain essential health benefits in order to market themselves on your state's Exchange as a Qualified Health Plan. These benefits include:

  • Addiction treatment
  • Care for children (including vision and dental care) and newborn care
  • Doctor visits and lab tests
  • Emergency care
  • Hospital care
  • Maternity care
  • Mental health services
  • Occupational therapy and physical therapy
  • Certain prescription medicines
  • Preventive care, like cancer screenings and vaccines
  • Speech-language therapy
  • Treatment for long-term diseases, like diabetes and asthma

Plans differ by the services they provide for each benefit. For instance, one plan may cover more prescription drugs. Only some plans may include bariatric surgery. And not all plans will cover in-vitro fertilization.

To make sure a plan will cover the care you need, make sure you take the time to look at the summary of benefits for any health plan you're considering. Then compare it to your current plan.

In a Marketplace, how many health plan choices will I have for each level of coverage -- bronze through platinum?

Your state and the federal government determine which insurance companies can sell on the Marketplace. All companies they allow must offer at least one silver-level plan and one gold-level plan. So your number of choices depends both on the state and federal government and on the insurance companies that sell plans in your  state.

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