The Four Metal Levels of Coverage Michigan Health Insurance Marketplace Premiums

The Four Metal
Levels of Coverage
By now, you likely have
heard Health Insurance
Marketplace plans referred
to as platinum, gold, silver
or bronze – the metal levels
of coverage assigned to all
plans. These levels reflect
how you and your plan
divide the cost of your care –
or in other words, how much
you pay and how much your
plan pays for any care you
receive.
It’s important to note these
levels don’t have anything
to do with the quality of
care you receive, only the
costs you might pay for your
care, including premiums,
deductibles and copays. For
example, a platinum plan
covers approximately 90
percent of expected services,
while you pay the remaining
10 percent. From there, the
amount covered goes down
by tier, while the amount
you pay out of pocket
goes up. (There are also
catastrophic plans available
to those under 30 years
old or those with hardship
exemptions.)
Remember: The actual
percentage you’ll pay
varies depending on the
services you use during the
year. According to www.
healthcare.gov, you should
consider factors such as
how many doctor visits
and prescriptions you
typically have in a year when
choosing a plan level; those
with many medical expenses
may want to consider a
higher-level plan. Another
important note: If you
qualify to save on out-ofpocket costs based on your
household size and income,
then you can get these
savings only if you enroll a
silver plan.
A: YOUR MONTHLY PREMIUM
B: COVERAGE OF EXPECTED COSTS
C: PERCENTAGE YOU'LL PAY
PLATINUM
A: $$$
B: 80%
C: 20%
SILVER
A: $
B: 60%
C: 40%
10 THINGS
A: $$$
B: 90%
C: 10%
GOLD
A: $$
B: 70%
C: 30%
BRONZE
Every Plan
Must Cover
The Affordable Care Act requires most Health Insurance
Marketplace plans in the individual and small group markets
to offer essential health benefits as part of their coverage. The
essential benefits are minimum requirements; some plans may offer
additional coverage. Note that there may be copays and deductibles
for some of these services and that grandfathered plans or plans
offered by large employers are not required to offer these services,
though many do.
The essential services most Marketplace plans must cover are:
1. Ambulatory patient services or care you receive without being
admitted to a hospital
2. Emergency services, including ambulance transportation
3. Hospitalization, including surgery
4. Laboratory services
5. Maternity and newborn care, both prenatal and postnatal
6. Mental health and substance use disorder services, including
behavioral health treatment such as counseling and
psychotherapy
7. Pediatric services, including oral and vision care for children
under 19 years old
8. Prescription drugs
9. Preventive and wellness services that help prevent chronic disease
10. Rehabilitative and habilitative services and devices, which
assist those with injuries, disabilities or chronic conditions to
gain or recover mental and physical skills
The Affordable Care Act Timeline
The Health Insurance Marketplace Open Enrollment Period started Nov. 15,
2014, and runs through Feb. 15, 2015. During this time, you can apply for a
new plan, keep the plan you have or switch plans.
Important dates to remember:
Dec. 15, 2014 –Last day to enroll if you want new coverage that begins
on Jan. 1, 2015
Dec. 31, 2014 –Coverage ends for all 2014 plans
Feb. 15, 2015 –Last day to enroll for 2015 plans during Open Enrollment Period
Special Enrollment Period:
You may still be able to enroll in a plan for 2014 if you qualify for the Special
Enrollment Period. Qualifying circumstances include marriage or divorce, having
a baby, adopting a child, placing a child for adoption or foster care, moving
your residence, gaining citizenship, leaving incarceration, losing other health
coverage due to losing job-based coverage, the end of an individual policy plan
in 2014, COBRA expiration, being too old for a parent’s plan, losing Medicaid or
CHIP and similar circumstances. Coverage for any 2014 plan you enroll in will
end Dec. 31, 2014.
When Does My Coverage Start?
If you enroll in a new plan or switch plans between now and
Dec. 15, 2014, then your new coverage will start Jan. 1, 2015.
After that, if you enroll or switch between the first and 15th
days of the month, your coverage will start the first day of
the next month. If you enroll or switch between the 16th and
last day of the month, then your coverage starts the first day
of the second following month. So if you enroll on Jan. 15,
your coverage would start Feb. 1; if you enroll Jan. 16, your
coverage starts March 1.
Michigan Health Insurance Marketplace Premiums
2015 Individual Market Rates by Metal Level, Plan and Rating Area
Affordable Decision
Care Act Guide 2015
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