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Deciding on the best type of health insurance can be confusing – especially with so many options to consider. But now plans are easier to compare by looking for clearly marked medallions. Health care reform requires plans in the individual and small-group markets to meet certain coverage standards, which are represented by metal levels: Bronze, Silver, Gold or Platinum. The levels indicate the actuarial value of the plan, which is the percentage of Essential Health Benefits (EHB) the plan pays. Take a look at a few key details to compare coverage levels and decide on a plan that best meets your needs and your budget.

*Please note that the potential out-of-pocket costs are distinct from the out-of-pocket limits set by the IRS, discussed in more detail below. The out-of-pocket costs are intended to reference potential additional expenses, such as rent or mortgage payments, child care costs, utility bills or transportation to and from treatment facilities.

Definitions and more information:

Essential Health Benefits: A set of health care categories that must be covered by certain plans. They include:1

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

For more information visit:

Out-of-pocket limit: The out-of-pocket limits established by the IRS for 2015 are $6,450 for individual coverage and $12,900 for family coverage. This means you will pay coinsurance – in a variety of ways as determined by your health plan – up to your out-of-pocket limit. These limits apply only to covered expenses, so if you or a family member incur non-covered expenses, they will not count toward your out-of-pocket limit. This adds to your potential unexpected costs.

Preventive Services: Routine health care that includes screenings, check-ups and patient counseling to prevent illnesses, disease or other health problems.1 For more information visit:

Premium: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.1

Federal Poverty Level: A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.1

Supplemental Insurance: Low-cost supplemental insurance such as accident, hospital and disability insurance will pay you cash for illnesses or injuries, helping you cover out-of-pocket costs that major medical insurance was never intended to cover.