HEALTH INSURANCE MARKET IN THE USA: EVERYTHING YOU NEED TO KNOW
The Health Insurance Marketplace , also known as the Health Insurance Exchange, is the place where people without insurance can find information about health policy options and shop for the ones that are best for them. You can also get exclusive information about eligibility for government help paying premiums and reducing out-of-pocket costs. Each year, this Marketplace has an open enrollment period.
In addition to the federally-facilitated Marketplace, which is called HealthCare.gov , there are also state-owned Marketplaces. The coverage options offered by state insurance markets may vary depending on the state where you live. On the other hand, if you visit the HealthCare website, you will be asked to provide your zip code . So if you live in an area served by a state market, you’ll be redirected to the website for your state market.
Read also: Find out how the System Works in the US
Who Buys in the Health Marketplace in the USA?
If you or your family don’t have health insurance coverage through your job, you can choose a health plan from the Government Marketplace and pay for it yourself. Now, if you ‘re self-employed or unemployed, the Health Insurance Marketplace is the place to go for affordable health policies. On the other hand, if your employer offers health insurance coverage, you can still shop on the Marketplace, but keep in mind that you’ll pay full price for your plan.
Everyone who buys from the Health Insurance Marketplace must be a US citizen and live in the United States. If you qualify for Medicare , you won’t be eligible to buy policies on the marketplace. Finally, it is important to mention that incarcerated people are also not eligible.
There are four levels of health plans that you can buy on the Marketplace and they are graded like this: Bronze, Silver, Gold and Platinum. (The “catastrophic” plans also exist and may be available to some people with specific profiles). It’s worth noting that each tier pays a different portion of your health care bills. Likewise, you will also pay a part of your health care expenses through your monthly premium, co-payments, deductible and coinsurance; remember that the amount of money you pay depends on the plan.
Grouping plans is the easiest way the US government found to get families enrolled in the Health Marketplace to save money. For example, there is a plan called “Top-of-the-line” which is Platinum where you pay 90% of your health care bills; And even though it costs more money for being the “most expensive” plan, this one also comes with an affordable premium.
The most basic plan that HealthCare offers is Bronze, where you pay 60% of your health care bills and it costs much less. Below, we show you a comparative table of the different plans and the costs for each level.
Important : Keep in mind that the levels are named after metals. Therefore, it is very common that you sometimes hear terms like “bronze plans” or “gold levels”, etc.
Plan Category The Plan Covers What you cover Price Rating
Bronze 60% 40% Under
Silver 70% 30% Means, medium
Prayed 80% twenty% High
Platinum 90% 10% Complete
What should I take into account when buying a policy in the US Health Insurance Market?
Next, we leave you a series of data that you must take into account before requesting a health policy with the Medical Insurance Market.
1) Coverage Available
All Marketplace health plans cover 10 essential health benefits defined by law. Now, how you and your health insurance company split the costs of care varies by plan level.
However, all Marketplace plans give you the same essential health benefits. For example, annual checkups , routine mammograms, and diabetes screenings are covered at 100% when you join the network; all this regardless of the plan you choose.
Each plan also gives you access to other vital care. For example: If you have to stay overnight in the hospital, go to an emergency room or clinic, get care for your children , or get therapy and other treatments to get better, you’ll be covered.
2) The more you pay, the greater the coverage
Higher-priced plans pay a higher portion of your eligible medical bills . In some cases, people pay higher monthly premiums to get a plan that covers most of their medical bills.
3) Take advantage of Co-Payments
Most plans have a co-pay option available . Remember that the actual co-pay amount will vary by plan and service.
4) Each Plan is Unique
Plans in the same metal tier may have different deductibles and different coinsurance. That’s because deductibles and coinsurance can vary between plans in the same metal tier. For example, two Gold plans may have the same annual maximum coverage, but different deductible and coinsurance amounts. So it’s best to read the fine print carefully before agreeing to a health insurance plan. This way, you will know what you have to pay when you receive health care.
5) Help to Make Payments
You may be able to get help paying for your health plan . Depending on your household size and income, your profile may qualify for federal financial assistance for your health plan through the Federal Government.
Which Health Insurance Marketplace Plan is Right for Me?
An HMO, or by its Spanish meaning “ Health Maintenance Organization ”, is a type of plan that offers a local network of doctors and hospitals that you can choose from. It generally has lower monthly premiums than a PPO or EPO health plan.
An HMO may be right for you if you prefer to choose a primary care provider ( PCP ) to coordinate your health care ; You must also be a person who is willing to pay a higher deductible to obtain a lower monthly health insurance premium.
A PPO, or ” Preferred Provider Organization, ” is a type of health plan that offers a larger network so you can choose from more doctors and hospitals . Out-of-pocket costs (monthly premium) are typically higher with a PPO plan than with an HMO or EPO plan.
So, if you’re someone who’s willing to pay a higher monthly premium for more choice and flexibility when choosing your doctor and health care options, you may want to go with this option.
An EPO, or ” Exclusive Provider Organization, ” is a type of health plan that offers a local network of doctors and hospitals that you can choose from. An EPO is usually cheaper than a PPO plan . However, if you choose to get care outside of your plan’s network, it generally won’t be covered (except in an emergency). If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need medical care, you may want to consider an EPO plan.