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Health Care Reform:

Health Insurance & Affordable Care Act

Your Insurance Choices in a Marketplace: FAQ

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 do have to provide certain essential 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 under hospital care. And not all plans will cover in-vitro fertilization under maternity care.

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

How can I get help paying for my insurance?

There are two ways you may be able to get help.

First, there is a tax credit that is based on three things:

  • Your income: Single people can make up to about $46,000 a year. A family of four can make up to about $94,000 a year.
  • How many people are in your family.
  • Where you live -- an area with a high or low cost of living.

A second kind of financial help is called a cost-sharing subsidy. This subsidy is a sliding scale to help reduce how much you have to pay each time you get health care. If you qualify, you'll have lower deductibles, copays, and coinsurance.

For this help, single people can make up to about $27,000 a year. A family of four can make up to about $55,000 a year. To be eligible for a cost-sharing subsidy, you have to enroll in a silver-level plan.

Will I get a larger tax credit if I pick a platinum plan?

No. If you buy insurance through a Marketplace, you may qualify for a tax credit that will help lower the cost of your premiums. But you won't get a larger credit for a higher level of coverage.

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