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From 1/1/2014 on, all individual and family health insurance plans will have these “Metallic” names whether you purchase health insurance “On Exchange” or “Off Exchange”. It gives you an easy-to-understand overview of how the plans will share the payment of your medical bills.
Health insurance companies that sell plans on the Health Insurance Marketplace can offer four types of qualified health insurance plans, including Bronze, Silver, Gold, and Platinum. The plan you choose determines not only the premium you pay but also what portion of your health costs you pay.
To make it easier to shop for coverage, health insurance plans have standardized “metals”. The “metal” plan depends on its actuarial value, or the average percentage of health care costs the plan pays vs what the member pays. The more coverage a plan provides, the higher the monthly premium and the fancier the metal level. Gold is better than Silver. Silver is better than Bronze.
This percentage will not go on forever, there is always an “Out of Pocket Maximum” (this is your pocket, not the insurance company), so you’ll only pay your portion of the expenses until you’ve reached your out-of-pocket maximum.
You’ll want to review your “Summary of Benefits and Coverage” to find out what your deductible is, your co-insurance, your out-of-pocket maximum, along with all of the important details of what your plan covers.
Regardless of the plan you choose, it will provide all 10 essential health care benefits guaranteed to policyholders under the Affordable Care Act. The difference among the plans has to do with how much overall out-of-pocket costs you’ll pay up to your out-of-pocket maximum.
Choosing the right metal tier requires evaluating your budget and assessing current and expected health care needs. Our agents guide you in reviewing the options available across the tiers and help you determine which plan best fits your health needs and budget. We can also help you determine whether you qualify for subsidies to lower your premium.
Sometimes, deciding whether to see a doctor is a gray area, but it’s better to err on the side of caution. If you are experiencing a serious injury or illness, it is easy to justify making a call to your local medical office. However, it is important to remember that early detection generally leads to better outcomes.
Health insurance pays for dermatology appointments in the same way that it does any other visit with a specialist. If the treatment you are seeking is “medically necessary”, and you have followed your plan’s rules for getting referrals or seeing in-network providers, you will not have to pay for your care entirely out of pocket.
Understanding your emergency room bill, including what charges are on there and whether they are fair, can help you spot discrepancies and potentially save you money.
By page visits (this month)
By page visits (this month)
In health insurance, an exclusion is a medical procedure or treatment that the health insurance company does not cover. This may include specific medications, surgeries or therapies that are specifically omitted from your policy.
Going through a divorce can be a very stressful time, and it is unlikely that your health insurance coverage is at the forefront of your mind throughout the proceedings.
If you move out of state, you’ll need to get coverage in your new state and need to report your move within 30 days and enroll into a plan within 60 days, but each state rules may vary. When you move, if you have insurance now, it would be considered a qualifying life event.
Vision insurance is supplemental health insurance that covers vision-related care. This includes annual visits and emergency care, along with corrective products such as glasses and contacts.