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.
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Essential health benefits: A set of health care categories that must be covered by certain plans. They include:1
For more information visit: https://www.healthcare.gov/glossary/essential-health-benefits/
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: http://www.hhs.gov/healthcare/rights/preventive-care/index.html.
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, and will help you cover out-of-pocket costs that major medical insurance was never intended to cover.
This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 800.318.2596) for additional information.