Life & Health Insurance
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Life & Health Insurance Information
Individual Health Insurance Plans
Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.
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The 4 "metal" categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
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Your total costs for health care: You pay a monthly bill to your insurance company (a "premium"), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.
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Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.
Remember that plans also may differ in quality.
How you and your insurance plan split costs
Estimated averages for a typical population. Your costs will vary.
Plan Category |
The insurance company pays |
You pay |
Bronze
|
60%
|
40%
|
Silver
|
70%
|
30%
|
Gold
|
80%
|
20%
|
Platinum
|
90%
|
10%
|
Which metal category is right for you?
Bronze
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.
- Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
Silver
- Moderate monthly premium
- Moderate costs when you need care
- Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.
IMPORTANT: If you qualify for cost-sharing reductions you must pick a Silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you use a lot of care.
- Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
Gold
- High monthly premium
- Low costs when you need care
- Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.
- Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.
Platinum
- Highest monthly premium
- Lowest costs when you get care
- Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
- Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered
Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible.
Your premium can be lower, based on your income
No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income.
When you fill out a Marketplace insurance application, you’ll find out if you qualify for these savings.
When to buy an individual health plan
You can purchase or make changes to individual health insurance during the open enrollment period. Open enrollment for most states is from Nov. 1 to Dec. 15 each year. States with their own exchanges usually offer expanded open enrollment.
For instance, states had these expanded open enrollment for 2020 plans were:
- California – Oct. 15 to Jan. 15
- Colorado – Nov. 1 to Jan. 15
- D.C. – Nov. 1 to Jan. 31
- Massachusetts – Nov. 1 to Jan. 23
- Minnesota – Nov. 1 to Dec. 23
- New York – Nov. 1 to Jan. 31
- Rhode Island – Nov. 1 to Dec. 23
The only other time you can get an individual health insurance plan is if you have a qualifying event that launches a Special Enrollment Period. These events may have caused you to lose your health coverage. The special enrollment period lasts 60 days.
Special enrollment qualifying events include:
- Getting married
- Having a baby, adopting a child or placing a child for adoption or foster care
- Moving
- Becoming a U.S. citizen
- Leaving incarceration
- Losing other health coverage due to job loss, divorce, COBRA expiration or aging off a parent’s plan
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
- People with a marketplace plan already may be eligible for a special enrollment period if there’s a change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies
- Gaining status as a member of an Indian tribe
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