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Types of Obamacare Plans

Choosing the right health coverage is easier once you learn about the differences among Obamacare plans.

The Affordable Care Act (ACA) has simplified health plans into four "metal" tiers of coverage. They consist of the following:

  1. Bronze plans
  2. Silver plans
  3. Gold plans
  4. Platinum plans

All four of the plans offer the exact same level of quality health care. In fact, by law, every Obamacare plan must at least provide for the Ten Essential Health Benefits. These benefits include: 1) ambulatory care; 2) emergency services; 3) hospital coverage; 4) maternity and newborn care; 5) pediatric services (including dental and vision); 6) mental health and addiction treatment; 7) prescription drug benefits; 8) rehabilitative coverage; 9) laboratory services; and 10) preventative services and chronic disease management.

The difference among all four plans has to do with how much they cost. In general, Bronze plans charge less upfront per month, but cost you more out-of-pocket when you need care. On the other end of the spectrum, Platinum plans have a higher monthly rate, but you pay less out-of-pocket -- for expenses such as deductibles, coinsurance, and copayments -- when needing care.

Plan Type
Medical Expenses You Pay (does
not include your premium)
Medical Expenses
the Plan Pays
Bronze
40%
60%
Silver
30%
70%
Gold
20%
80%
Platinum
10%
90%

When choosing a plan it is best to consider your total costs for health coverage. Some key questions to ask yourself include: How often will I need to see the doctor? Am I comfortable paying less per month, but risking higher out-of-pocket costs if I were to go to the doctor, fall ill, or need emergency care?

Typically, those who just want a low monthly premium, and do not think they will need much more than preventative care usually opt for a Bronze plan. Those who regularly need medical services typically go with a Gold or Platinum planSilver plans are a popular choice, as many find they strike a nice balance between low monthly rates and out-of-pocket costs. Silver plans uniquely offer some cost-savings benefits, which are discussed in detail below and more here.

You could substantially save on your plan’s monthly rate if you qualify for the Premium Tax Credit. The Premium Tax Credit was created to help make insurance affordable for all. Specifically, if you meet certain income guidelines, the federal government will help pay for -- or subsidize – your monthly insurance bill. The payment is made directly to the insurance company on your behalf. Think of it like a discount applied on top of your plan.

Generally speaking, those with lower incomes qualify for a larger Premium Tax Credit, and will pay less per month. All four metal plans can receive the Premium Tax Credit.

Cost Sharing Reductions can help you save even more by lowering your out-of-pocket costs. Like the Premium Tax Credit, you must meet certain income guidelines to qualify for Cost Sharing Reductions. Similarly, those with lower incomes tend to receive a greater reduction amount, meaning they would pay less out-of-pocket for deductibles and copayments (e.g. when using their insurance).

As discussed, Cost Sharing Reductions are only available with a Silver plan. Those who qualify for both the Premium Tax Credit and the Cost Sharing Reduction can substantially lower their total cost for health coverage. Many find that it is "the best of both worlds, "meaning they pay the low monthly rate of a Bronze plan, while paying the low out-of-pocket costs of a Gold plan. Not surprisingly, Silver plans have become very popular.

Catastrophic plans are a fifth type of plan. Although they have the lowest monthly cost, the benefits are primarily limited to emergency situations, and you must meet certain eligibility requirements. As their name suggests, these plans provide health coverage during "worst-case" emergency scenarios. Catastrophic plans have the most affordable monthly rates, even lower than the rates of Bronze plan, however, their out-of-pocket costs tend to be the highest. Also unlike the metal plans, preventive care benefits are limited.

Plan Type
Out-of-Pocket Costs You Pay
How Much the Plan Pays
Catastrophic
More than 40%
Less than 60%

To qualify for a Catastrophic plan, you must either be under the age of 30, or have a hardship exemption at any age. You may qualify for a hardship if you are experiencing:

  • Homelessness;
  • An eviction/foreclosure;
  • A notice of shutoff from your utility company;
  • Domestic violence or a death in the family;
  • A natural or man-made disaster.
  • Bankruptcy or substantial debt from medical expenses;
  • An increase in expenses due to caring for an ill, disabled, or aging family member;
  • Claiming a child as a tax dependent who was denied Medicaid or CHIP;
  • If you won an appeal for previously being denied a qualified health plan, but were denied eligibility at the time;
  • You lost coverage in the past, but found qualified health plans to be unaffordable;
  • Some other hardship related to obtaining health insurance.

To start comparing plans, as well as to check your eligibility for the premium tax credit, please submit your zip code to begin the process. You can also call (833) 762-8166 to speak with an agent.

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Federal Contracting Statement: The Medicare plans represented are PDP, HMO, D-SNP, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. No Obligation to enroll.

TPMO Disclaimer: We do not offer every plan available in your area. Currently we represent [73] organizations which offer [5110] products in your area. Please contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Please note that these numbers provided are not specific to your area but rather represent the number of organizations and the number of products available on a national basis. We will connect you with licensed insurance agents who can provide information about the number of organizations they represent and the number of products they offer in your service area.

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The plans represented on MarylandHealthplans.org are Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. If you are paying Medicare Part B premium, you must continue to pay it to maintain coverage.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

Based on median Medicare Advantage benefit amounts for dental available across multiple plans and metro areas. Not all benefits available in specific plans or regions.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

[Benefits, premiums and/or copayments/coinsurance] may change on January 1 of each year.

Enrollment in a plan may be limited to certain times of the year unless you qualify for a special [election/enrollment] period or you are in your Medicare Initial Election Period.

Advertised Pricing:

There are several factors that impact your monthly premium; including your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

MarylandHealthplans.org is operated by QuoteLab, LLC, which is an independent broker and is not a federal or state insurance Marketplace or other website. It does not provide access to any federal or state marketplace or exchange. This website is owned and operated by QuoteLab, LLC, a licensed insurance agency, NPN #19911386. Invitations for application for health insurance are made through QuoteLab, LLC, only where licensed and appointed. License numbers are available upon request and are provided where required by law. QuoteLab's license information can be found at https://www.quotelab.com/licenses.html.

This website does not provide information about specific health plans, or enable visitors to obtain insurance quotes, on this website. However, if you provide your information and consent, we will transfer your information to insurance carriers and brokers that may contact you to offer Affordable Care Act (ACA) plans, short-term plans, medical indemnity plans and/or healthcare sharing ministry plans, and we will receive compensation for such transfer. The advertisements appearing on this website are placed by clients from which QuoteLab, LLC receives compensation, and such compensation may impact whether such advertisements appear on this website and the order in which they appear.

MarylandHealthplans.org is required to comply with all applicable federal law, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website does not provide a complete listing of, or display all data on all Qualified Health Plans being offered in your state or service area through the Marketplace website or the federal Medicare program. To see all available data on Qualified Health Plan options in your state, visit your state Marketplace website, go to the Health Insurance Marketplace website at https://www.healthcare.gov.

This site uses cookies and tech to collect data needed for our services to work including to process your requests, personalize your experience, and measure the effectiveness of content we show you, among other business purposes (Learn More). We share this data with the business partners we connect you with, who may combine it with data you provide to them or they collect from you (Learn More). To learn more about cookies and how to disable them, read our Privacy Policy.

Note that even with a $0 premium Medicare Advantage plan, you'll still pay a monthly premium for Part B, and a Part D premium if your Medicare Advantage plan does not include prescription drug coverage (MA-PD).

Allowance Disclaimer: Allowance amounts cannot be combined with other benefit allowances. Limitations and restrictions may apply.

** Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved groceries and utilities. Unused amounts will expire at the end of the month or quarter.

*The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan’s Evidence of Coverage.

Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.

1Transportation services are issued as one-way trips and provided on an annual basis. Benefits vary by plan.