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Finding out where you stand on the health insurance’s podium.

2014 marks the year where health reform law, aka ObamaCare, will be fully enforced and completely change the health insurance world. Starting in 2014, all American citizens/ legal residents are required to have health insurance coverage. Health insurance can be obtained through employer, insurance company, Medicare, Medicaid, VA coverage, or Exchange(s). If either the individual or company does not obtain insurance they will be penalized by paying a fee. In the insurance world, instead of adapt or die, it is play or pay. ObamaCare will impact every aspect of health insurance from the providers to the individuals.

For now I will just discuss the individuals’ plan. Each individual’s plan is standardized to 4 plans; bronze, silver, gold or platinum. Unfortunately, there is no association between these metal-named plans and winning actual medals. However, unlike a race where you have to compete to be the best, in the health insurance you get to choose what is best. These plans do standardize the types of benefits and cost-sharing in health which makes it easier for you to compare options. Each of the plans is required to offer/cover all the following essential health benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and therapy services and devices
  • Laboratory services
  • Preventive and wellness
  • Pediatric dental and vision

Bronze plan offers the least coverage while platinum offers the most. Each of these plans can be purchased in a health insurance Marketplace, also called an Exchange.

Below is the percentage of health care costs each individual pays for each type of plan.

  • Bronze Plan: 40%
  • Silver Plan: 30%
  • Gold Plan: 20%
  • Platinum Plan: 10%

In other words, with the bronze plan the individual will have to pay more out of pocket on a doctor visit but will pay a smaller premium per month. The platinum plan is opposite, where the individual pays little out of pocket, but has a greater premium per month. However, if no plan is purchased the penalties are as follows,

  • 2014: $95 per uninsured adult (capped at $285 per household) or 1% of household income
  • 2015: $325 per uninsured adult (capped at $975 per household) or 2% of household income
  • 2016: $695 per uninsured adult (capped at $2,085 per household) or 2.5% of household income

That is individuals’ plan in a nut shell. I hope this helps in figuring out where you stand in the health insurance world. Whether it be bronze, silver, gold, or platinum; finding what suits your needs is what is most important. Knowing just the basic outline of these plans will better equip you when the time comes to select the right insurance.



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