Monday, November 4, 2013

What Different Kinds of Insurance Can I Buy on the Marketplace?

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next several years. Texas physicians and the Texas Medical Association have carefully studied the law to help you understand what the changes mean to your health care. 

As the Affordable Care Act (ACA) continues to roll out, Me&My Doctor’s “Hey Doc” series will answer your frequently-asked questions, as well as some you might not have thought to ask. 

Check out part 11 in this series.

Q. What different kinds of insurance can I buy?

A. There are different kinds of insurance plans you can buy depending on how much you want to spend, the medical services you need for you and your family, and how many doctors and hospitals you want to choose from. Some plans, for example, only let you use the doctors that are in their networks; otherwise, you pay more. Others might require you to get a referral from your regular doctor before you get other specialized treatments. You can read up on and about the different kinds of insurance plans out there.

The marketplace also puts these different kinds of insurance plans into four categories: bronze, silver, gold, and platinum. The categories are based on the amount of coverage the insurance company provides for your health care, and your portion of the costs. But again, any plan in any of those categories still has to offer essential benefits. The difference is how you and your insurance company share the costs of that care.

There is a fifth option, too, called “catastrophic insurance.” But it’s only for certain people, and it doesn’t cover everything.

Q. What is catastrophic insurance?

A. Catastrophic insurance is meant to be a sort of safety net that covers you when something like a major accident or serious illness comes up. It only covers three regular doctor visits a year and certain preventive care. So your monthly charge, or premium, might be lower for catastrophic insurance, but you will likely have to pay higher costs out of your own pocket before full coverage kicks in for things like essential benefits. In the marketplace, catastrophic plans are only available to people under 30 years old and certain people who don’t earn much. And if you buy one of these plans, you won’t be eligible for any financial assistance to help pay for it.

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