ACA plans refer to health insurance plans that are sold on the health insurance marketplace. These marketplaces are managed by the state or federal government. By law, All ACA plans must cover certain essential benefits. These benefits must include:
- Emergency services
- Outpatient services
- Maternity care
- Mental health care
- Behavioral health services
- Prescription drug coverage
- Rehabilitative services
- Habilitative services
- Pediatric services
- Preventive and chronic disease management services
There are four different types of ACA plans: PPO, POS, HMO, and EPO.
PPO, HMO, POS, and EPOs
Preferred Provider Organization plans (PPO) are one of the most popular ACA plans. PPO plans allow you to visit any in-network provider without requiring a referral. Also, the plan provides coverage for in-network and out-of-network care, though out-of-network care costs more. If you want the freedom to choose any healthcare provider or you want some out-of-network care coverage, then PPO plans may be right for you.
HMO plans will require you to choose a primary care doctor, and you will need a referral for specialist visits. However, many HMO plans have lower out-of-pocket costs. This is because HMOs provide healthcare coverage that is limited to in-network providers.
Point of Service plans are basically a combination of HMO and PPO plans. Like an HMO, a POS will require you to choose a primary care doctor and get referrals when needed. But, like a PPO plan, you can also receive your care outside of the provider network, though this will cost more.
With Exclusive Provider Organization (ECO) plans, you can exclusively use the healthcare providers within the plan network but cannot get coverage for out-of-network care.
ACA Plan Categories
ACA plans are also grouped by metal tiers, or categories. The metal tiers are not used to determine the quality of care. They are used to determine how the costs will be split between you and your chosen plan.
The four metal tiers are bronze, silver, gold, and platinum. In the bronze plan, 60% of medical costs are paid by the insurer, while the consumer covers 40%. Bronze tier plans have the lowest monthly premiums, but the highest out-of-pocket costs.
Silver plans cover 70% of medical costs while the policyholder covers 30%. The monthly premium cost is considered moderate compared to higher tiers.
Gold plans have higher premiums but lower deductibles. They cover 80% of the medical costs, while you cover 20%.
Platinum tier plans cover 90% of the medical costs. They have the lowest deductibles but have the highest premiums. However, the plan will cover almost all the medical costs.
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At iHealthcare, our agents will guide you through the process of choosing an affordable health insurance plan suitable for your healthcare needs. For more information on how we can help, call us today at 713-900-1901.