Essential Health Benefits
•A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
•Plans must offer dental coverage for children. Dental benefits for adults are optional.
•Specific services may vary based on your state’s requirements. You’ll see exactly what each plan offers when you compare plans.
Four Levels of Coverages (Metal Plans)
Cost when you get care
Good option if
You're healthy and don't see the doctor often
You want to balance monthly premium and cost when you get care
- Most people choose this option.
You plan to use your health insurance often
You can afford a higher monthly premium so that you pay less when you get care
• High monthly premium
• Low costs when you need care
• Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.
• Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.
• Highest monthly premium
• Lowest costs when you get care
• Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
• Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.
• Find out how to use total costs of care to pick a category and plan that work for you.
• Moderate monthly premium
• Moderate costs when you need care
• Silver deductibles
— the costs you pay yourself before your plan pays anything
— are usually lower than those of Bronze plans.
• If you qualify for “extra savings” on your deductible, copayment, and coinsurance (sometimes called “cost-sharing reductions”) you must pick a Silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you use a lot of care.
• Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
• Lowest monthly premium
• Highest costs when you need care
• Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay
— can be thousands of dollars a year.
• Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible.