Insurance Costs Under the Affordable Care Act

he cost of insurance in the Health Insurance Marketplace will depend on your income and how much coverage you need. When looking for a plan, consider two questions:

  • How much will you pay monthly (premium)?
  • How much will you owe on top of that (deductibles, copays, etc.)?

Four tiers of approved coverage will be sold through the marketplace: Bronze, Silver, Gold and Platinum. The categories differ by how much your premium costs each month and how much you pay yourself when you receive care. They are not based on plan quality. Bronze will cost you less per month, but have higher out-of-pocket costs. Platinum will have higher monthly premiums, more generous benefits and lower out-of-pocket costs.

Each tier of coverage will pay for a specified portion of your health care costs:

Do you expect to receive a lot of medical care like doctor visits and prescription medications? You may want a platinum or gold plan. If you're not expecting to need a lot of health care services, the bronze plan may be a good option, but keep in mind that you'll be on the hook for more of your costs if you have an accident or unexpected health problem.

There is a fifth option that basically only covers worst-case scenarios. A "catastrophic" plan will protect you from only the very high medical costs. To qualify, you need to be under 30 or have a very low income as determined by the marketplace; if you don't qualify, you won't see catastrophic plans listed in the marketplace.

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Do you qualify for discounts, subsidies or Medicaid?

The 100 percent column shows the federal poverty level for each family size in 2013. Under the Affordable Care Act, families who earn less than 400 percent of the federal poverty limit are eligible for subsidies to help pay for their insurance. Families who make less than 250 percent of the federal poverty limit are entitled to discounts on their out-of-pocket insurance expenses (copays and deductibles). And the Medicaid program has been expanded to now include families who make less than 133 percent of the federal poverty limit. Check the graph below to see if you or your family qualifies for any of these discounts or plans.

AARP, American Public Health Association, Centers for Medicare & Medicaid Services, Consumer Reports, FAIR Health, Inc., HealthCare.gov, Internal Revenue Service, Kaiser Family Foundation, Medicaid.gov, Michigan Department of Community Health, Michigan Department of Insurance and Financial Services, U.S. Chamber of Commerce, U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs.

Every effort was made to provide clear, accurate information about health care reform. We verified any information we had with first-tier sources – those who are involved in this change and its effect on our health care system. We also relied on well-respected national nonprofits, some who've done a masterful job of providing clear information to consumers. Our primary source of information was the Affordable Care Act's official website, HealthCare.gov. If you need additional information about how health care reform affects you, that would be your best place to start.

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