• Print:
  • Text Size:

A Look at Health Care Reform

Know the Covered Benefits

Many things about the new ACA plans are different from what you may be used to prior to health care reform. ACA plans must include key Essential Health Benefits as well as no-cost preventive services for all consumers.

Expand All | Collapse All

Essential Health Benefits & No-cost Preventive Services

The law requires that all plans cover these Essential Health Benefits:

  • Ambulatory patient services
  • Maternity & newborn care
  • Prescription drugs
  • Laboratory services
  • Preventive/wellness care
  • Pediatric dental & vision care
  • Emergency services
  • Hospitalization
  • Mental health/substance abuse services
  • Rehabilitative/habilitative services & devices

All plans also must offer preventive services at no charge. You won’t pay a copay or co-insurance for these services and you don’t have to meet your deductible before you use these no-charge services, including:

  • Adult physicals and blood pressure/cholesterol screenings
  • Well-child care visits and immunizations
  • OB/GYN visits
  • X-rays and diagnostic/lab tests
  • Cancer screenings such as mammograms, pap tests, prostate and colorectal screenings
  • Routine pre-natal maternity visits
Metal Level

Under the ACA plans (except high-deductible Catastrophic plans) must also fit into one of four-Metal Levels. Bronze, Silver, Gold & Platinum. These plans cover the same core benefits, but plans at each level have different monthly premiums and varying out-of-pocket costs. Also for people who qualify, the ACA has created subsidies to help cover the cost of plans.

Different Plans have different monthly premiums and out-of-pocket costs for you.

Metal Level
What the Health Plan Pays
What You Pay
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%
Your monthly premium rate is a separate cost and is not included in these calculations.

Insurance companies used to have a nearly infinite number of combinations of premiums and how much of your heathcare costs you would pay. Being forced to fit into specifically defined Metal Levels means less flexibility when it comes to pricing. You’re likely to end up paying a higher premium to keep your out-of-pocket costs down, or you’ll end up paying more when you receive care in exchange for a lower monthly premium.

Understanding Subsidies

To help make health care more affordable, the ACA created two types of financial assistance, known as Subsidies, for low- and middle-income people who buy insurance on a public exchange:

  • You may qualify for financial help to lower your monthly premium if your projected total household income in 2014 will be:
    • less than $45,960 for an Individual
    • less than $62,040 for a Family of 2
    • less than $78,120 for a Family of 3
    • less than $94,200 for a Family of 4
    • less than $110,280 for a Family of 5

To get an estimate of what you may receive ina Subsidy, check out our Subsidy Calculator on our compare and quote website. The Cost-Share Subsidy can help limit how much you’ll have to pay out of pocket for your health care, and can only be applied to Silver plans purchased on a public state Exchange. You may be eligible if your projected total household income for 2014 will be:

  • Less than $28,725 for an Individual
  • Less than $38,775 for a Family of 2
  • Less than $48,825 for a Family of 3
  • Less than $58,875 for a Family of 4
  • Less than $68,925 for a Family of 5

In order to qualify and receive a Subsidy and buy the ACA plan you will need to apply for the Subsidy on a public state Exchange. Subsidies are not available to individuals who receive health insurance through an employer.

Expand All | Collapse All