10-12-2022 PTL - Flipbook - Page 20
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A Special Advertising Section of Baltimore Sun Media Group | Wednesday, October 12, 2022
COVERAGE LEVELS
Coverage Levels
percent insurance
pays
Insurance coverage
premium options
Bronze, Silver, Gold, Platinum
By Margit B. Weisgal, Contributing Writer
Monthly Premium
Out-of-Pocket Expenses
Platinum 90%
Gold 80%
Silver 70%
Bronze 60%
T
here are several levels or tiers of insurance plans through the Maryland Health
Connection named after metals – Bronze, Silver, Gold and Platinum – to differentiate between them. Plans in these categories differ based on how you and
the plan share the costs of your care and from whom and where you can get medical
treatment.
When you enroll in a metal tier plan,
a percentage of your medical costs is
paid by the insurance company, and the
balance of the invoice is your copay,
deductible and out-of-pocket expenses.
Generally speaking, the more you pay
for your monthly premium, the more the
insurance company pays toward your
care. Conversely, when you select a
lower cost plan, the less the insurance
company pays and the more you pay
in out-of-pocket costs and the deductible. The most popular plan is Silver.
And if you are eligible for cost-savings
reductions to lower your costs (“reduced
out-of-pocket costs like deductibles and
copays”), you will need to enroll in the
Silver plan.
Above is a chart to see the different percentages. MHC points out that
“Health plan categories are based on
how you and your plan split the costs of
your health care. They have nothing to
do with quality of care.”
Before you choose a plan, MHC provides some information on how they differ and when they are a good choice for
you to make.
• Bronze Plan: You want a low-cost
way to protect yourself from worstcase medical scenarios, like serious
sickness or injury. Your monthly
premium will be low, but you’ll have
to pay for most routine care yourself.
• Silver Plan: You qualify for “extra
savings” – or, if not, if you’re willing to pay a slightly higher monthly
premium than Bronze to have more
of your routine care covered.
• Gold Plan: You’re willing to pay
more each month to have more
costs covered when you get medical treatment. If you use a lot of
care, a Gold plan could be a good
value.
• Platinum Plan: You usually use a lot
of care and are willing to pay a high
monthly premium, knowing nearly
all other costs will be covered.
Catastrophic Plans
There is one other level that is separate from these four tiers. Referred to as
a catastrophic plan, it has low premiums,
but you pay for almost all your care.
These plans still cover essential benefits.
Think carefully before choosing a
catastrophic plan. Monthly costs are
very low, but if something major should
happen, you will be required to pay a
fixed amount or deductible – it could be
thousands of dollars or more – before
the insurance company starts paying for
the care. According to HealthCareInsider
(https://healthcareinsider.com/), the current deductible is $8,000.
This is good when you don’t have sufficient income for more comprehensive
plans. Should you have a major medical
emergency, after your deductible the
comprehensive insurance will go into
effect. Those under 30 and some people
with limited incomes, called a hardship
exemption, may buy a catastrophic plan.
If this is something you are considering,
speak with a certified insurance broker
so that you know all the ramifications of
this choice before you make your decision and make sure you understand how
much money is involved. It’s worth asking if there are other possibilities.
Other Options
If you qualify for cost-sharing reductions – reduced out-of-pocket costs
like deductibles and copays – you can
access these savings only by choosing
a Silver plan. Cost-sharing reductions
are not tax credits. You could qualify for
both a tax credit and cost-sharing. This
option is only available if you a file tax
return with the IRS. A credit is added to
your tax refund.
There is one warning about receiving
tax credits. If the information you used
with MHC is not correct and you receive
more money in tax credits than is justified, you will have to return this extra
money to the IRS.