What are the "metal" plans?


The Affordable Care Act (ACA) requires that all individual plans fall into certain categories with respect to how they coverage eligible expenses.  Here’s a breakdown of what is covered under each metal tier for a standard population (or those that are not eligible for government-sponsored subsidies based on income level):


Bronze  - must have an actuarial value of 60%.  This  means that  the member (you) will pay for 40% of medical costs through a combination of deductibles, copays and coinsurance. 


Silver - must have an actuarial value of 70%.  This means that the member (you)  will pay for  30% of medical costs through a combination of deductibles, copays and coinsurance.


Gold  - must have an actuarial value of 80%.  This means that the member (you) will pay for 20% of medical costs through a combination of deductibles, copays and coinsurance.


Platinum - must have an actuarial value of 90.  This means that the member (you) will be responsible for only 10% of medical costs through a combination of deductibles, copays and coinsurance.


 As a general rule of thumb: the higher the actuarial value, the less cost-sharing responsibilities (deductibles, copays and coinsurance) for the member, but the higher the premium.   So your Bronze plans will provide the lowest premiums and the Platinum plans will have the highest premiums.



When can I enroll for coverage?

To buy individual insurance outside the normal Annual Open Enrollment Period, you must qualify for a special enrollment period due to a qualifying life event such as marriage, birth or adoption of a child, or loss of other health coverage. You generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage.


If you don’t have a special enrollment period, you can’t buy individual insurance until the next Annual Open Enrollment Period. You may be able to enroll in a plan if you've had certain life events. Some examples are:

• Marriage

• Birth or adoption of a child

• Loss of health coverage (due to job loss, divorce, death, or other reason)

• Move to a different county

• Change in income that may affect your subsidy


The Open Enrollment period for 2022 coverage is November 1, 2021 through January 15, 2022.

Important Enrollment Dates:


• 2021 Open Enrollment

• Healthcare.gov and COVID-19

• Medicaid & CHIP enrollment

Things you need to know.......

​Learn about the Affordable Care Act

The Affordable Care Act (ACA) requires that almost everyone in the U.S. to have health insurance beginning in 2014. If you don't, you may have to pay a fee, called the individual shared responsibility payment to the Federal government. 

Will I qualify for a federal subsidy? 

Have Questions?  Call us......

1-866-438-8271

 

YOUR HEALTH INSURANCE EXPERTS

 

Total Benefit Systems

 ACA informational video presented by Kaiser Family Foundation



What are Essential Health Benefits?


  • As part of the Affordable Care Act, medical plans for individuals and families must cover 10 kinds of health care services. These services are called essential health benefits:
  • • Outpatient 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
  • • Pediatric vision