Private companies and government programs offer several types of coverage levels and health plans, which makes the Health Insurance Marketplace a complex environment that may be hard to understand. However, there is an easy way to explain all of the market’s different offerings and help you navigate the Health Insurance Marketplace to choose what option best fits your needs.
The Health Insurance Marketplace is divided in four categories: Bronze, Silver, Gold and Platinum. An additional level, which goes by the name “Catastrophic,” is also available to certain people who meet particular requirements.
- Bronze: The Bronze coverage level is typically recommended to people who only want to have a health insurance plan for emergency situations. This is the level that typically offers the lowest monthly premiums but incurs the highest deductibles. Thus, routine exams are often accompanied by high out-of-pocket payments.
- Silver: The Silver coverage level is often well suited for people who quality for “extra savings” within their health insurance plans. This is a level with slightly higher monthly premiums but slightly lower deductibles in comparison to Bronze.
- Gold: The Gold coverage level is typically recommended to people who require somewhat regular medical care. This level charges higher monthly premiums but offers lower deductibles in comparison to Silver.
- Platinum: The Platinum coverage level is often well suited for people who require very regular medical care. When compared to all other categories, this is the level with the most expensive monthly premiums and lowest deductibles in the marketplace.
- Catastrophic: Only people under 30 years of age or who qualify for hardship exemption may be eligible to enroll in a Catastrophic coverage level. This level offers low monthly premiums but very high deductibles, thus only being recommended for people who rarely need medical care.
Each coverage level has several health plan offerings. When making a decision about which health plan to pick, your physician’s evaluation and your specific medical needs should be taken into account.
- Health Maintenance Organization (HMO): Unless you experience a medical emergency, this health plan will typically require you to live within the plan’s network and will only allow you to see doctors within that network.
- Exclusive Provider Organization (EPO): This health plan will also only allow you to see doctors within the plan’s network, unless you experience a medical emergency. However, there is typically no requirement regarding where you may or may not reside.
- Point-of-service (POS): If you are given a referral, this health plan will allow you to see a doctor outside of the plan’s network. However, the deductibles for out-of-network doctors will likely be higher.
- Preferred Provider Organization (PPO): This health plan will allow you to see an out-of-network doctor even if you did not receive a referral. However, the deductibles for doctors that operate outside of your plan’s network will be higher.