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Health plans for individual and small groups are required to offer health insurance that meets certain levels of coverage. Like those coveted Olympic medals, health plans are ranked according to their value, beginning with the bronze and climbing to the higher end platinum plan.

These values show the percentage of the total average costs for covered benefits that a plan will cover, and are designed to help individuals better understand their benefits. Use the chart below to learn more about and compare plan levels.

*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: https://www.healthcare.gov/glossary/essential-health-benefits/.

Out-of-pocket limit: Out-of-pocket limits are established annually by the IRS. These limits apply not only to covered benefits, and if an individual or family incurs expenses for noncovered benefits, these will not count toward their out-of-pocket limit, adding to potential unexpected costs.

Preventive Services: Routine health care that includes screenings, checkups 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 helping you cover out-of-pocket costs that major medical insurance was never intended to cover.