In the few years since the Affordable Care Act has been introduced, Ohio health insurance plans have undergone a massive change. Not only are certain benefits now mandated, but plans have also been standardized. Here's what this means for you.
Here's examples of Affordable Care Act (Obamacare) plans
These plans are often referred to as "heavy metal plans.” Before you get excited and think a free Metallica or Anthrax concert is one of the benefits, it’s the plan names that helped earn the name “heavy metal”- Bronze, Silver, Gold and Platinum.
So what’s the difference between these plans?
Each plan requires a different level of out-of-pocket from you. Here’s the levels for each plan:
- Bronze- 60%
- Silver- 70%
- Gold- 80%
- Platinum- 90%
The percentage refers to the cost-sharing of medical expenses between you and the insurance company. For example: with the bronze plan, you can expect the insurance company to pick up 60% of your health care expenses and you pick up the balance. For example, let’s say you need your appendix removed. That surgery costs $25,000. If you have a Gold-level plan, the insurance company will pay $20,000 (80%). You pay the remaining $5,000 (20%).
Just like it is today, the better your benefit, the more the premium. So, a Platinum plan will cost more than a Bronze plan.
What do the plans cover?
All plans must include “essential health benefits.” This includes items and services within the following 10 categories:
-Ambulatory patient services (a common example includes visits to the doctor)
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management- a nice benefit of many plans is that these services are often covered at 100%.
- Pediatric services, including oral and vision care
Need more information? We're Ohio health insurance specialists and can help you navigate the confusing world of health insurance. Call Alan Galvez Insurance at (937) 592-4871 or visit our health insurance resources- you can request your quote as well!