The Affordable Care Act Simplified

  • Understanding your health plan options

    Many people get their health insurance through their employers. But if your employer doesn’t offer health insurance, or if you’re unemployed or self-employed, you'll still need a health plan. That’s where individual insurance comes in. You shop for, purchase, and enroll in a plan, and then pay for your monthly premiums yourself. Despite its name, you can purchase individual insurance for your entire family, not just for yourself.

    There are three major factors to consider when shopping for a health plan:

    • What’s covered—the benefits. Under the Affordable Care Act, all health plans are required to cover 10 essential health benefits. But Premera offers a variety of health plans that go above and beyond these 10 benefits.
    • The provider network. The doctors, pharmacies, hospitals, emergency rooms, and other healthcare providers you can see at the “in-network” level, which means you’ll pay less.
    • Costs (bronze, silver, or gold plans). This includes both up-front monthly costs and what you pay later on if you see a doctor or get other medical care.

    Premera can help you decide which plan is best for you, and learn whether you qualify for financial help with your health plan costs. We can also help you buy a plan. Call us weekdays from 8 a.m. to 7 p.m. at 855-738-0954 with any questions.

    Bronze, silver, and gold plans

    You’ve probably heard the terms bronze, silver, and gold plans. These terms refer to how much you’ll pay. They don’t refer to the benefits in a plan and they don’t rate the quality of the medical care you’ll receive.

    There are three important kinds of costs to consider:

    Premiums. Up-front monthly costs that you pay regardless of whether you use any healthcare services. This is similar to the bill you pay for car or home insurance, regardless if you ever have an accident or file a claim.

    Cost shares or out-of-pocket costs. This is what you pay if you see a doctor or get other medical care. You pay only a share of the cost, and your health plan pays the rest. Common cost shares are deductibles, copays, and coinsurance.

    Out-of-pocket maximum. The maximum amount you could have to pay in a year for covered services from in-network providers.

    What’s best for you? 

    Which plan is best for you depends on several things, but primarily on whether you have some health or medical problems and expect to need a lot of medical care and services during the year, or whether you are in excellent health and need a health plan just in case something happens.

    Keep in mind, all plan levels—bronze, silver, and gold—cover most preventive care, in full, with little or no out-of-pocket cost to you.

    Bronze $

    • Lowest monthly premiums
    • Higher out-of-pockets costs—deductibles, copays, and coinsurance
    • Higher out-of-pocket maximums (the most you’ll pay in a year)
    • On average, pay 60 percent of your healthcare costs
    • May be the best choice if you don’t expect to need much medical care

    Silver $$

    • Higher monthly premiums than bronze, lower than gold
    • Lower out-of-pocket costs than bronze, higher than gold
    • Lower out-of-pocket maximums than bronze, higher than gold
    • On average, pay 70 percent of your healthcare costs
    • The “middle” choice

    Gold $$$

    • Highest monthly premiums
    • Lowest out-of-pocket costs
    • Lowest out-of-pocket maximums
    • On average, pay 80 percent of your healthcare costs
    • May be the best choice if you expect to need a lot of medical care

    Plans with HSAs

    Another term you’ll see in some plan names is HSA, which stands for health savings account. These plans generally have high deductibles, meaning you’ll pay that amount for medical costs before your health plan’s coverage kicks in. These plans may have special tax advantages, and allow you to set up a special bank account for medical expenses. Because these plans have high deductibles, they generally have lower premiums. You should make sure you understand how these plans work before choosing them.

    Other factors that affect the cost of plans 

    • The number of people to be covered by the health plan
    • The ages of people covered
    • Where you live (your county)
    • Your income—this determines whether you are eligible for financial assistance
    • Whether you use tobacco

    Call us at 855-738-0954 with any questions about your health plan.