CHANGES IN THE MARKETPLACE

October 4, 2013 No Comments by admin

The marketplace for health insurance is no longer what it used to be. The Affordable Care Act (ACA) has made it so that health plans, on and off the exchange, have to offer the same benefits.

Therefore, everyone is switching to the metal tier system: platinum, gold, silver, and bronze. What this means is the benefits you receive within Covered CA or through another provider are one in the same. Of course, this also depends on what metal tier you choose. For instance, the silver tier on the exchange will give you the same benefits as it would off the exchange. If you go with the gold tier, on or off the exchange, your benefits are the same, but your deductible is lower or nonexistent and your monthly premium increases (this is in comparison to the silver tier).

There are some other differences to take into consideration. A major difference is the chance for a subsidy when purchasing insurance through Covered CA. Another major difference is when you purchase insurance off the exchange your networks may become much broader.

So, before you start looking at those low monthly premiums, first take a look at a few things such as, the networks being offered for each plan, how much of a tax credit you get when buying through Covered CA, and are there any additional benefits being offered by plans off the exchange.

Below is an article from healthcare.gov that outlines what essential health benefits are.

What does Marketplace health insurance cover?

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.

The essential health benefits include at least the following items and services:

Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (such as surgery)
Maternity and newborn care (care before and after your baby is born)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Essential Health Benefits

A set of health care service categories that must be covered by certain plans, starting in 2014.

The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.

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