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Obamacare Q&A: What's the difference between silver, bronze, platinum?

October 02, 2013|By Chad Terhune
  • A medical assistant, right, checks the blood pressure of a patient at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S.
A medical assistant, right, checks the blood pressure of a patient at a Community… (Andrew Harrer / Bloomberg )

Thousands of consumers started shopping in new health insurance exchanges this week as enrollment in Obamacare launched in California and across the country.

Many people are unsure what President Obama's Affordable Care Act will mean for them. They have questions about how much insurance will cost and what type of benefits will be available, among many other concerns.

Join this Twitter chat with reporter Chad Terhune, who has covered healthcare for many years at The Times and other publications. Tweet questions to @chadterhune and he will answer them Wednesday.

Those different metal tiers, from bronze on the low end to platinum at the high end, are available to all consumers. It just depends on what level of coverage you’re seeking and how much you’re willing to spend.

Workers don't have much control over the cost of employer-provided insurance. Premiums have been rising steadily and employers increasingly ask workers to contribute more. You can pick a higher deductible plan to save on premiums in some cases.

The unemployed may qualify for no-cost coverage through an expansion of Medicaid, depending on what state they live in. California has accepted federal money to expand its Medi-Cal program.

Beyond that, there are federal premium subsidies for lower-income people. Check the Covered California rate calculator online and punch in some income levels to see what coverage may cost.

You would need to check the specific health plan and what their rules are on out-of-state care. Some major insurers that operate in multiple states can help with that.

You also need to be careful when choosing out-of-network care in general because your share of the medical costs can increase substantially.

No, you don't have to wait until COBRA ends or take it at all. But these new exchange health plans don't take effect until Jan. 1 at the earliest, so you don't want to have a break in coverage. You can also check rates now on the Covered California calculator to see how it compares to COBRA premiums, which usually run pretty high.

Yes, you can switch, but I would carefully check the prices and benefits before making any move. You should look at all of your out-of-pocket costs, premiums plus deductibles and copays, to make a sound comparison.

One key factor will be how much your employer is contributing to your health plan. That should probably be your first option. Also, does your employer help pay for dependent coverage? Many firms have cut back on that.

Then check the Covered California rate calculator to see whether you qualify for federal premium subsidies based on your income. Families earning less than $94,000 a year can receive some financial help.

That could make coverage there more affordable. There’s plenty of time to consider all these options. Enrollment in the state exchange runs through March 31.

Residents in the country illegally are not eligible for federal subsidies in the government-run exchanges like Covered California. There are other county and private programs that may assist people with their medical bills.

Yes, the benefits are the same in each metal tier, such as platinum. That makes it much easier for an apples-to-apples comparison among health plans.

One of the biggest factors driving the difference in price then is the network of doctors and hospitals the insurers are offering for that policy. Some may be a more limited HMO plan. Others may be a PPO plan with greater choice of physicians and specialists.

Many health plans have restricted their provider networks in the exchange to help hold down rates, so consumers should ask about that before signing up.

The IRS penalties for not having health insurance start relatively small in 2014 at $95 per adult or 1% of income, whichever is greater. They increase over time. In 2016, they reach $695 or 2.5% of income.

Also:

Full coverage: Obamacare rolls out

Demand for Obamacare strong in California

Examining your health insurance options under Obamacare

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