All ACA health plans are categorized into Bronze, Silver, Gold and Platinum levels of coverage. Each category offers the same set of Essential Health Benefits. The categories do not reflect the quality or amount of care the plans provide.
The “metal” plan category you choose affects the total amount you’ll likely spend for essential health benefits during the year. The percentages the plans will spend, on average, are:
(Note: “Metal Categories” are NOT the same concept as coinsurance, in which you pay a specific percentage of the cost of a specific service.) The category that you choose affects how much you’ll pay in premiums each month and what portion of the medical bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs —the total amount you’ll spend for the year if you need lots of care.
There are also “catastrophic” plans to people under 30 years old and to some people with very low incomes. A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. Costs for essential health benefits over that are generally paid by the insurance company. Catastrophic plans have lower premiums than a comprehensive plan, but cover you only if you need a lot of care. They basically protect you from worst-case scenarios. Catastrophic policies cover 3 primary care visits per year at no cost and include free wellness benefits.
People 30 and over with low incomes for whom other insurance is not considered affordable or who have received a HARDSHIP EXEMPTION from the Tax Penalty for no insurance may be able to buy these catastrophic plans. You can apply through TheMedicalInsuranceExchange.com for the Hardship Exemption and then apply for a catastrophic plan.