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Which Obamacare Health Plan is Right for You?

If you are a taxpayer with an income at least 100 percent of the poverty level and no more than four times the poverty line, then you are an excellent candidate for an Obamacare health plan.  Not only do these plans provide outstanding benefits including free annual checkups, free preventive care, mental health and addiction services, and prescription drug discounts, but they also offer financial protection from catastrophic injury or illness. If you qualify for an Obamacare plan, you may also receive a government subsidy that can lower your monthly premium by hundreds of dollars.

In 2010, the U.S. Congress passed the Affordable Care Act (ACA) that created federal and state health insurance marketplaces.  These ACA-sponsored marketplaces are available to individuals or families who wish to obtain a government-subsidized health insurance policy.  There are a wide variety of health plans in each local marketplace, so it is important to examine the financial requirements of each plan before choosing one for you.

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Multiple Tiers

Each of the Obamacare health plans falls into one of four tiers: Bronze, Silver, Gold or Platinum. Additionally, there are Catastrophic plans which offer minimal benefits for a very low price.  These metal plans differ primarily in how much financial protection they offer and how much of any medical expenses you are responsible for. Like most health insurance policies, you pay less for less financial coverage and vice versa.

At the lowest tier are Catastrophic health plans that are intended to provide payouts only in the case of a major medical crisis.  If you encounter an emergency, your Catastrophic plan will pay less than 60 percent of your medical bills, leaving the rest up to you.  However, these plans require only a very low monthly premium to maintain.  This type of plan is ideal for young enrollees without any ongoing health problems.

Bronze level plans are low premium plans that pay about 60 percent of any medical expenses.  Although you are responsible for a small monthly premium to maintain the policy, you must usually pay a substantial annual deductible before your insurer will start making any payouts to your care providers. Once again, this type of low premium-high deductible plan is designed for healthier enrollees with a limited need for ongoing medical care.


The next higher tier is Silver which typically covers 70 percent of medical bills, leaving you responsible for the remaining 30 percent.  Like Bronze plans, Silver plans have a low monthly premium but a higher annual deductible. 

Gold plans offer expansive coverage benefits for a relatively high monthly premium.  In addition to covering 80 percent of the medical costs, Gold plans also do not have an annual deductible.  This means that your insurer will start paying your medical bills from day one. You will still have to pay 20 percent of bills through co-payments, co-insurance or other charges.

Platinum health plans are the highest tier plans and offer the most coverage of any Obamacare plan. These excellent health insurance policies will pay 90 percent of your medical expenses and do not have an annual deductible.  There are substantial monthly premiums associated with Platinum health plans. These policies are recommended for enrollees who see a physician quite often.

Network Restrictions

More than half of all the health insurance policies found on the ACA-sponsored exchanges are health maintenance organization (HMO) plans. HMO plans are often the most restrictive type of network, with a limited number of physician and medical specialists available to enrollees. However, health plans with HMO networks usually have the lowest premiums. Almost 41 percent of all Obamacare plans fell into the HMO category in 2015, but this grew to 52 percent in 2016 because insurers wanted to offer more low premium plans.

In addition to a limited number of physicians, HMO network plans also require that you select a primary care physician who will oversee your medical care. If you wish to visit a specialist, you will need to get permission from your primary care doctor. Within the HMO framework, your insurer will not pay for any visits to out-of-network doctors.

If you plan on seeing physicians outside your network, you are better off choosing a Preferred Provider Organization (PPO) plan. PPO plans will reimburse these out-of-network providers some or all of the cost of such visits, but you will probably have to pay more in monthly premiums.  You also do not need a primary care physician to sign off on every visit to a specialist—although your insurer may require that you provide prior notification. 

The third type of network that many Obamacare plans fall into are Exclusive Provider Organization or EPO plans. These plans lie in the middle ground between PPO and HMO plans. They allow you to see specialists without a referral from a primary care doctor, but you will not get reimbursed for seeing a doctor out of your network. Most EPO plans are very cost effective.

Financial Obligations

If you are concerned about how much an Obamacare policy is going to cost you, you should consider your deductible and other out-of-pocket expenses in addition to the size of your monthly premium.  You should also keep in mind how healthy you are likely to be while under coverage.  If you are fairly healthy, you are unlikely to see a physician more than once or twice a year, so paying for a low premium-high deductible plan is probably ideal for you. Because you probably won’t need to see a medical specialist, you can also choose a low cost HMO or EPO plan network.

On the other hand, if you suffer from frequent health problems, then you may wish to go with a health plan that has higher monthly premiums but fewer out-of-pocket responsibilities. This means you will be paying less each time you see a doctor and you will be responsible for a smaller portion of medications and treatments.

If you would like additional information about Obamacare health plans, please visit Boost Health Insurance.

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