Countdown to Coverage: Choosing A Health Plan

Katharine Ligon

Selecting a health care plan for you or your family can be intimidating, especially if this is your first time and/or you have a chronic condition such as mental illness.  As we have shared with you in our blog series, Countdown to Coverage, there is a lot to understand before you select a plan and for people who suffer from mental illness and substance use disorders, there are important things to consider when selecting a plan in the Marketplace.

Prior to the ACA, many health plans did not included coverage for mental health and substance abuse services or if they did, the benefits where less than those offered for physical conditions.  Also, insurance companies could flat-out deny coverage to those with pre-existing conditions like mental illness.  However, under the ACA, each plan in the Marketplace will have to provide core benefits, known as the essential health benefits, including mental health and substance abuse services and insurance companies can no longer deny coverage because of pre-existing conditions.

Most individuals who are uninsured will be able to gain coverage through the Marketplace, which will offer a variety of health insurance plans.  Plans will be presented in four tiers – bronze, silver, gold, and platinum – which makes it easy to compare plans.

The tier you choose affects how much your premium costs each month and your total out-of-pocket costs like copays and deductibles.  Individuals with chronic conditions generally visit the doctor more frequently and take more prescription medications, which means more out-of-pocket costs within a year.

When choosing your health plan, keep this in mind:

  1. The bronze, silver, gold, and platinum plans do not reflect the quality or amount of care the plans provide.
  2. All plans in all tiers will contain essential health benefits
  3. In general, the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.  For example, the Bronze plan will generally have a lower premium but a higher out-of-pocket cost than a Silver plan.
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