The Four Metal Levels of Coverage By now, you likely have heard Health Insurance Marketplace plans referred to as platinum, gold, silver or bronze – the metal levels of coverage assigned to all plans. These levels reflect how you and your plan divide the cost of your care – or in other words, how much you pay and how much your plan pays for any care you receive. It’s important to note these levels don’t have anything to do with the quality of care you receive, only the costs you might pay for your care, including premiums, deductibles and copays. For example, a platinum plan covers approximately 90 percent of expected services, while you pay the remaining 10 percent. From there, the amount covered goes down by tier, while the amount you pay out of pocket goes up. (There are also catastrophic plans available to those under 30 years old or those with hardship exemptions.) Remember: The actual percentage you’ll pay varies depending on the services you use during the year. According to www. healthcare.gov, you should consider factors such as how many doctor visits and prescriptions you typically have in a year when choosing a plan level; those with many medical expenses may want to consider a higher-level plan. Another important note: If you qualify to save on out-ofpocket costs based on your household size and income, then you can get these savings only if you enroll a silver plan. A: YOUR MONTHLY PREMIUM B: COVERAGE OF EXPECTED COSTS C: PERCENTAGE YOU'LL PAY PLATINUM A: $$$ B: 80% C: 20% SILVER A: $ B: 60% C: 40% 10 THINGS A: $$$ B: 90% C: 10% GOLD A: $$ B: 70% C: 30% BRONZE Every Plan Must Cover The Affordable Care Act requires most Health Insurance Marketplace plans in the individual and small group markets to offer essential health benefits as part of their coverage. The essential benefits are minimum requirements; some plans may offer additional coverage. Note that there may be copays and deductibles for some of these services and that grandfathered plans or plans offered by large employers are not required to offer these services, though many do. The essential services most Marketplace plans must cover are: 1. Ambulatory patient services or care you receive without being admitted to a hospital 2. Emergency services, including ambulance transportation 3. Hospitalization, including surgery 4. Laboratory services 5. Maternity and newborn care, both prenatal and postnatal 6. Mental health and substance use disorder services, including behavioral health treatment such as counseling and psychotherapy 7. Pediatric services, including oral and vision care for children under 19 years old 8. Prescription drugs 9. Preventive and wellness services that help prevent chronic disease 10. Rehabilitative and habilitative services and devices, which assist those with injuries, disabilities or chronic conditions to gain or recover mental and physical skills The Affordable Care Act Timeline The Health Insurance Marketplace Open Enrollment Period started Nov. 15, 2014, and runs through Feb. 15, 2015. During this time, you can apply for a new plan, keep the plan you have or switch plans. Important dates to remember: Dec. 15, 2014 –Last day to enroll if you want new coverage that begins on Jan. 1, 2015 Dec. 31, 2014 –Coverage ends for all 2014 plans Feb. 15, 2015 –Last day to enroll for 2015 plans during Open Enrollment Period Special Enrollment Period: You may still be able to enroll in a plan for 2014 if you qualify for the Special Enrollment Period. Qualifying circumstances include marriage or divorce, having a baby, adopting a child, placing a child for adoption or foster care, moving your residence, gaining citizenship, leaving incarceration, losing other health coverage due to losing job-based coverage, the end of an individual policy plan in 2014, COBRA expiration, being too old for a parent’s plan, losing Medicaid or CHIP and similar circumstances. Coverage for any 2014 plan you enroll in will end Dec. 31, 2014. When Does My Coverage Start? If you enroll in a new plan or switch plans between now and Dec. 15, 2014, then your new coverage will start Jan. 1, 2015. After that, if you enroll or switch between the first and 15th days of the month, your coverage will start the first day of the next month. If you enroll or switch between the 16th and last day of the month, then your coverage starts the first day of the second following month. So if you enroll on Jan. 15, your coverage would start Feb. 1; if you enroll Jan. 16, your coverage starts March 1. Michigan Health Insurance Marketplace Premiums 2015 Individual Market Rates by Metal Level, Plan and Rating Area Affordable Decision Care Act Guide 2015