Health plan options

The insurance marketplaces offer health plans in your area at four levels of cost and coverage.
The main difference between plans is:

Where to get health insurance

If you're not already covered through your employer, Medicare, Medicaid or through a private health plan, you'll be able to purchase health insurance through the health insurance marketplace during open enrollment. These new one-stop shopping site make it easier to compare and sign up for individual health insurance plans and see if you qualify for subsidies. You can also buy individual insurance through a broker, but there are no subsidies available on these plans.

How the health insurance marketplaces work

This new place to shop for insurance is also called an exchange and it's open to individuals, families and small businesses (). During open enrollment, you can...

  • Find and compare costs, benefits and features of health plans in your area.
  • Enroll in a plan and see if you qualify for help paying for health insurance premiums and/or get lower deductibles and copays with subsidies.

You can also see if you qualify for free or low-cost coverage under Medicaid or the Children's Health Insurance Program at any time.

Insurance plans that count

You're all set if you're covered under health insurance plans you get through:

Plans the marketplace sells

The marketplace offers four different levels of insurance plans: Bronze, Silver, Gold, and Platinum.

  • Bronze plans cover 60% of medical costs, you cover 40%.
  • Silver plans cover 70% of medical costs, you cover 30%.
  • Gold plans cover 80% of medical costs, you cover 20%.
  • Platinum plans cover 90% of medical costs, you cover 10%.

Bronze has the lowest premiums and highest out-of-pocket costs. Platinum has the highest premiums and lowest out-of-pocket costs.

What marketplace plans must cover

No matter which level plan you buy (Bronze, Silver, Gold, Platinum), it must offer minimum essential coverage, which includes:

  • Ambulatory patient services (outpatient care, without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including counseling
  • Prescription drugs
  • Rehabilitative services and devices for people with injuries, disabilities, or chronic conditions
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Preventive and wellness services

Under Obamacare, all marketplace plans and all qualified health plans must cover the following services without charging you a copay or coinsurance, even if you haven't met your annual deductible.

You must meet certain qualifications, such as age, for some of these:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screening and counseling
  • Aspirin to prevent heart disease
  • Blood pressure screening for adults
  • Cholesterol screening
  • Colorectal cancer screening
  • Depression screening for adults
  • Diabetes (Type 2) screening for some adults
  • Nutrition counseling for some adults
  • HIV screening for everyone ages 15 to 65
  • Vaccinations for adults
  • Obesity screening and counseling for all adults
  • Sexually transmitted disease prevention counseling for adults
  • Syphilis screening for higher-risk adults
  • Tobacco use screening for all adults; help for tobacco users

Plans that don't count

The following types of plans do not meet Obamacare requirements for qualified health plans:

  • Worker's compensation
  • Insurance for a specific disease or condition, such as cancer insurance
  • Plans that only cover dental or vision care
  • Plans that only offer only discounts on medical services
  • Insurance for long-term care

Choosing a marketplace plan

To pick the insurance plan that best fits your current needs, it helps to add up your medical costs over the past year. If you visit the doctor often or have many prescriptions, a Gold or Platinum plan may work out better cost-wise than a Bronze or Silver plan. If you want to pay a lower monthly premium, and don't visit the doctor often, a Bronze plan could be better for you.

Keep in mind that there's no single "best" plan, but the new health insurance marketplace has tools to make it easier to find options that match your health needs and budget.

Keeping your current doctor

Depending on which plan you choose in the marketplace, you may be able to keep your current doctor. Check the list of providers in each plan's network when shopping for plans, and make sure your doctor is in the network before choosing a plan.

When to enroll in a health care plan

There will be one open enrollment period per year when people who want health insurance are guaranteed to have their application approved. The first open enrollment period ended on March 31, 2014. The next open enrollment period will run from November 15 through February 15. Certain life events qualify you for a special open enrollment period that lasts 60 days from the date of the event.

If you miss open enrollment

To qualify to get a health insurance plan and get help paying for it outside the open enrollment period, you must have a qualifying life event, such as:

  • Getting married or divorced
  • Having, adopting, or getting custody of a child
  • Permanently moving somewhere that offers different health plan options
  • Losing other coverage due to job loss, divorce, loss of Medicaid or CHIP eligibility, or COBRA expiring.
  • For people who already have marketplace coverage, having a change in income or household status that affects what you qualify for.

If you don't have a qualifying event, you can still sign up for a plan through a private marketplace, but it will not meet the requirements of the new law and no subsidies will be available to help you pay for it.

About catastrophic health care plans

Catastrophic plans provide health care coverage in case of emergency. They do cover three visits to a primary care doctor per year and offer free preventive services. Monthly premiums tend to be about 20% lower than most plans, but annual deductibles are usually much higher. You'll likely have to pay several thousand dollars toward your care before the insurance company starts paying for covered services.

In the marketplace, catastrophic plans are available to:

  • Those under 30
  • Some with limited incomes or facing hardship
  • People whose insurance plans were cancelled and now aren't able to afford a marketplace plan

If you have COBRA

Since COBRA meets the Obamacare minimum coverage requirement, you don't have to buy additional health insurance in order to avoid paying a penalty fee.

However, even if you have COBRA, you can shop the health insurance marketplace during open enrollment to compare plans and see if you qualify for lower costs on your monthly premiums and/or out-of-pocket costs. You'll also find out if you qualify for free or low-cost coverage from Medicaid. If you find a better option in the marketplace, you'll have to drop your COBRA coverage effective on the date your new plan takes effect.

You can stay on your parents' plan until 26

If your parents' plan includes coverage for children, you can be added or kept on the policy until you turn 26 years old. This applies even if you are:

  • Not living with your parents
  • Attending school
  • Married
  • Not financially supported by your parents
  • Eligible for insurance through an employer

Dental and vision care insurance

You aren't required to have dental and/or vision coverage under the Affordable Health Care Act. If you want to get coverage, here are some options:

  • Choose a health plan that includes dental and/or vision coverage. You will pay one premium for everything.
  • Purchase stand-alone plans for dental and vision. You will need to pay additional premiums for this coverage.

About Medicaid

Medicaid is a government program that provides health insurance coverage to low-income U.S. citizens and their children. If you're eligible, you receive free or low-cost health care.

Since Medicaid eligibility is expanding in some states under the Affordable Care Act, you may be eligible for Medicaid now, even if you weren't in the past. In states that expanded the program, Medicaid will now be offered to individuals under age 65 with income less than about $15,302 ($31,155 for a family of four).

How to qualify and apply for Medicaid

Here are two ways to apply:

  • Find your state's Medicaid website. You can apply right now and find out if you qualify.
  • Apply for insurance at the health insurance marketplace. By completing the application, you can find out which programs you qualify for. If you (or a family member) are Medicaid eligible, Medicaid will automatically be alerted so they can contact you.

About Medicare

Medicare is a federal health insurance program primarily for U.S. residents who are 65 and older. Medicare is also available to people with certain illnesses or disabilities. If you are already enrolled in Medicare, you don't need to make any changes to your health care plan. Having Medicare meets the Obamacare requirement that all U.S. residents have health insurance in 2014.

How to qualify and apply for Medicare

You may qualify for Medicare, even if you are not 65 or older, if you are disabled or meet other qualifications. To find out if you are eligible for Medicare, visit Medicare.gov. If you are eligible, you can either apply online or at your local Social Security office.