Your health plan is a contract between you and the insurance company you choose. When you purchase a plan, the insurance company agrees in paying part of your health costs, which varies according to each specific plan. The plans offered by the Marketplace provide free preventive care, such as vaccines and the annual checkup. They also may cover a portion of prescription medicine.

Did you know the average cost of a three day hospital stay is US$ 30,000? Or that a broken leg might cost around US$ 7,500 to take care of? Having health insurance can help you protect yourself from unexpectedly high cost health bills like these. In the Summary of Benefits of your plan you will be able to check your coverage by type of care, treatments, services, as well as your costs versus the company’s costs.

Be sure to understand how your plan works – premiums, deductibles, out of pocket, copayments, and coinsurance. These terms will come in handy when picking and using your plan.

Through the Marketplace you will be able to pick a plan with good balance between cost and coverage. By getting familiar with health terms and usage before using the plan, you should have no issues. Make a list of questions before picking your health plan. For example: “Can I keep going to Dr Jones?”, “Can I keep taking this medicine?”, or “Will I be covered when I travel?” It is ideal to ask questions before defining a plan.

When comparing Marketplace plans, have in mind they are divided into four categories and the category you fall under will change according to factors such as what you expect from the company, how much the company is willing to cover, and even your household setup. The categories are Silver, Bronze, Gold, and Platinum.

Usually you pay a monthly amount (premium) just to have coverage and access to your health plan. You might also have to pay a yearly deductible before the company starts sharing costs, depending on which plan you choose.

Besides that, you will also have a copayment for whenever you need to have a service done.

For example:

• Deductible: Deductible: what you pay before the company starts sharing costs

• Coinsurance e Copay: Coinsurance: what you pay after the company starts sharing costs. Copay: preset amounts you pay each time you need a certain service

• Out of Pocket: Out of Pocket: the maximum amount you will pay during the year with all services combined, as long as you use in-network providers

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No. There is no full coverage health insurance in which you pay only a monthly premium and services are all free/included.

There will be other costs such as copay, coinsurance, deductible, out of pocket… Only after you reach your plan’s out of pocket the company will cover 100% of your services for the year, however you will still need to pay your monthly premium.

The premiums are calculated through a tool that takes into consideration age, gender, number of members in the family, zip code, county, and most importantly, estimated household annual income. Families with lower income receive more Tax Credit, and so their premiums are usually lower. Families with higher income receive less Tax Credit, and so their premiums are usually higher as well.

When comparing Marketplace plans, have in mind they are divided into four categories and the category you fall under will change according to factors such as what you expect from the company, how much the company is willing to cover, and even your household setup.

The categories are Silver, Bronze, Gold, and Platinum. Silver plans, for those who qualify, get “Extra Savings” meaning they have smaller copays and out of pockets. You may qualify if your household is under the poverty line by 200%. The category you choose will influence premium, copay, deductible, and out of pocket however it will not influence at all in the quality of care, quantity of service, or coverage limit.

Equilibrium between monthly premium and service costs

Like in any health plan, you will have a monthly premium. Usually the Gold and Platinum categories have higher premiums than Silver and Bronze, but their copays are smaller. In a Bronze plan you would have a cheaper premium than Gold or Platinum, put the copays would be bigger. In a Silver plan, if you qualify for Extra Savings, you would have smaller premiums and smaller copays.

In general when picking a plan think that if the premium is low, the copays will be high. If the premium is high, the copays will be low.

If you are going to need to use the plan a lot and do not qualify for a Silver category, it might be worth considering a Gold or Platinum plan. Their premium might be a bit more expensive, but their copays and out of pocket will be less than the Bronze plans

Evaluate your options

The majority of people who are eligible to get a Marketplace plan are also eligible to receive Tax Credit, a government incentive that makes premiums more affordable. This incentive is directly related to the family’s income tax and is calculated according to each household. To know how much Tax Credit you and your family could receive, please have the following ready:

• Social security of all members
• Date of birth
• Paycheck, W2, or 1040
• Information about health insurance you or your family might have been offered through work