- Using the Marketplace
How do I choose Marketplace insurance?
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic. The categories help you choose a plan that’s right for you.
5 categories of Marketplace insurance plans
When you compare Marketplace insurance plans, they're put into 5 categories based on how you and the plan can expect to share the costs of care:
All Marketplace insurance plan categories offer the same set of essential health benefits. The categories do not reflect the quality or amount of care the plans provide.
The category you choose affects how much your premium costs each month and what portion of the 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.
The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Note: Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness -- are available to people under 30 years old and to people who have hardship exemptions from the fine that most people without health coverage must pay. Learn more about catastrophic plans.
Balancing monthly premiums with out-of-pocket costs
As with all health plans, you'll have to pay a monthly premium. But it's also important to know how much you have to pay out-of-pocket for services when you get care.
Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold plan, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
With a Bronze plan, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
Platinum plans will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care.
In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.
What to consider when choosing your plan
Think about the health care needs of your household when considering which Marketplace insurance plan to buy.
Do you expect a lot of doctor visits or need regular prescriptions?
If you do, you may want a Gold or Platinum plan.
If you don't, you may prefer a Bronze or Silver plan. But keep in mind that if you get in a serious accident or have an unexpected health problem, Bronze and Silver plans will require you to pay more of the costs.
What if I can't afford insurance?
When you fill out a Marketplace health insurance application, you'll find out whether you can get lower costs on your monthly premium or out-of-pocket costs. This may make insurance more affordable than you think.
Depending on your income, you may be able to get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Many states expanded their Medicaid programs to cover people at higher income levels. Even if you didn't qualify for coverage in the past, you may qualify now. When you apply, the Marketplace will tell you if you qualify under your state's rules.
When you apply for coverage, the Marketplace will determine whether coverage is affordable for your income level. If coverage is not considered affordable to you, you will not have to pay the fine that other people who do not have coverage may face.
If you have no insurance, you can use a community health center in your area to get health care.
How much will a plan cost?
You'll learn how much a plan costs after you fill out a Marketplace health insurance application. The price shown will include any savings you qualify for.
When you fill out a Marketplace application, you'll be able to compare plans side-by-side based on price and other features important to you. You'll also learn if you can save money on your monthly premiums or get lower out-of-pocket costs.
What plans should I consider if I travel a lot or spend time in more than one state?
If you live in one state and work or spend a lot of time in another state, carefully check the provider directories of the plans you’re thinking about buying.
See if their networks have doctors, hospitals, and other health care providers in the places you’ll be. Also check out the plan’s payment policies for out-of-network care.
- Some plans have networks that cover only part of one state. Other plans have networks that cover much of the country.
- If you use a doctor or facility that’s not in your plan’s network, you may have to pay more for the services you get.
Marketplace plans must have a link to a provider network directory on their website – and the directory must have the most current listing of in-network providers. You can also contact the plan to confirm your doctor or facility is part of the network.
HealthCare.gov provides direct links to provider directories for all Marketplace plans, so you can easily tell what your plan covers.