Types and Levels of ACA Health Plans
Types and Levels of ACA Health Plans
The government's health exchange Marketplace includes several kinds of plans, and each plan can have up to four levels.
Types of plans
There are several different kinds of plans available for individuals and families in the Marketplace. Here's a sampling:
Health Maintenance Organization (HMO) plans generally require you to use doctors within the plan's network, except in emergencies. Your primary care doctor will provide most of your care. If you need to see a specialist, you'll typically need a referral.
Preferred Provider Organization (PPO) plans usually let you see doctors outside the plan's network, but often charge more if you go outside the network. You aren't required to have a primary care doctor and typically don't need a referral to use out-of-network doctors, although you may pay more.
Point of Service (POS) plans, like PPOs, usually charge less when you use doctors and services within the plan's network. They're different from PPOs in that you typically need a referral from your primary care provider if you want to see a specialist.
Plan "metal" levels
The health insurance Marketplace assigns "metallic" names to the various levels of coverage, ranging from the highest rate of coverage (platinum) to the lowest rate of coverage (bronze). The higher the rate of coverage, the higher your monthly premium is likely to be.
Platinum plans cover about 90% of your health-care costs on average, and you pay the rest (about 10%).
Gold plans cover about 80% of your health-care costs on average, and you pay the rest (about 20%).
Silver plans cover about 70% of your health-care costs on average, and you pay the rest (about 30%).
Bronze plans cover about 60% of your health-care costs on average, and you pay the rest (about 40%).
Catastrophic is a separate category, available only to people who are either under 30 years old or have a hardship exemption. You may qualify for a hardship exemption if your situation interferes with your ability to get health insurance; for example, if you're homeless (or were homeless recently) you may qualify. Catastrophic plans generally cover less than 60% of your health-care costs on average and premiums are usually lower than standard health plans, but you may have to pay a substantial deductible before the plan pays for your care.
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