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Bronze Level Marketplace Plans

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The bronze plan is one of four metal categories of insurance plans created by the Patient Protection and Affordable Care Act (ACA) and available through the healthcare marketplace. Bronze plans cover the same ten basic health benefits that all plans available on the marketplace must offer:

  • Ambulatory Services
  • Emergency Services
  • Laboratory Services
  • Prescription Drug Coverage
  • Hospitalization
  • Preventive Care
  • Maternity Care
  • Pediatric Services
  • Mental Health Services
  • Rehabilitative Services

Bronze plans are intended to have the lowest premium of any of the health plans offered through the exchanges. They are the minimum health insurance plans that will satisfy the requirements of the ACA.

Out-of-Pocket Expenses

Bronze plans will generally cover 60% of the costs of the basic health benefits. The additional 40% of costs will be paid for by the beneficiary in out-of-pocket expenses. These figures are based on calculations of how much healthcare will be used by the entire pool of enrollees of a particular plan. Therefore, cost sharing for individual plans may vary.

Some plans may have a high deductible, while others may have a high co-pay or co-insurance payment. No matter how a bronze plan calculates cost Pages sharing, the out-of-pocket expenses is capped yearly, for an individual at $6,350, and $12,700 for a family. Out-of-pocket expenses include deductibles, co-insurance, co-pays, and costs for services not covered under the plan. The monthly premium is not considered an out-of-pocket expense.

In some cases, bronze plans may have a higher premium than silver plans, so it is important to look closely at your options before you purchase a plan on the exchange. Be sure to study the Summary of Benefits and Coverage carefully, which provides cost sharing details in a standard format so that plans can easily be compared.

Catastrophic Coverage

For consumers under 30 who meet certain income requirements and cannot afford any other health insurance plan, a low-cost catastrophic plan may be available. Catastrophic plans, available only to individuals, require a hardship exemption certifying that the individual cannot afford any other health plan available. While these plans still cover the ten essential health benefits, they have a significantly higher deductible than any other plan available. In addition, they provide deductible-free coverage for only three annual primary care visits and for preventative care. Catastrophic coverage should only be obtained after an individual has eliminated plans that qualify for cost-sharing reduction or premium tax credits.

Need Help?  Contact RedQuote!

As we administer COBRA for the employers we work with, RedQuote helps beneficiaries compare their COBRA plan with numerous individual plan options to help them choose the best plan for their age, budget and coverage preferences. If your company might be interested in hiring us to offer these options to beneficiaries coming off your group medical plan, contact us today!

Published Dec 8, 2016.

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