What Is Covered by a Marketplace Health Plan?

The health care marketplace, also known as the “marketplace” or “health insurance marketplaces,” was designed to assist the public when it comes to obtaining affordable health insurance.

The goal of the Affordable Care Act (ACA) is to lower the number of uninsured people by providing a means for them to buy insurance even if they have a pre-existing medical condition.

The marketplace is an online portal where people can compare health insurance plans, prices, and coverage to find the one that best fits their needs. However, how do you know what your plan covers?

There are five categories of health care services that plans can cover, including:

• Outpatient care (such as office visits)
• Emergency room visits
• Hospitalization (such as surgery or overnight stays)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical control of their bodies)

There are also three types of plans you can choose from:

• The bronze plan provides the lowest monthly premium but requires you to pay 40% of your health care costs. The other 60% will be covered by a federal subsidy. In addition, you will need to pay 40% of the cost for any health care services you receive.

   

• A silver plan is more expensive than a bronze plan because it is designed to provide more coverage. With this type of plan, you only pay 30% of your health care costs and the federal government covers the remaining 70%.

  However, silver plans can have higher deductibles (the amount you must spend before insurance will pay) and out-of-pocket costs. You will pay 40% of the cost for health care services you receive.

• The last type of plan is a Gold plan. It costs more than silver plans but has lower deductibles and out-of-pocket costs. You only pay 20% of your health care costs, with the federal government covering 80%.

Make sure that your plan covers at least 60% of your costs and provides “Essential Health Benefits.” These Essential Health Benefits (EHB) include:

• Outpatient care (such as office visits)
• Emergency room visits
• Hospitalization (such as surgery or overnight stays)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services

 If you have questions about how your plan covers these services, you can reach out to a Skyline Insurance Agency health advisor for more details.