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Government Health Plans: Affordable and Accessible Health Care for All

Government Plans were established by the Affordable Care Act to provide every American with quality health coverage that is truly affordable and attainable.

There are four types of Government Plans. Known as the “metal plans,” they are categorized as

  1. Bronze,
  2. Silver,
  3. Gold, and
  4. Platinum.

There is also a fifth plan that is known as the Catastrophic Plan. It provides limited coverage at a low cost for emergencies and serious medical events.

What Do Government Plans Cover?

Each of the four metal plans -- Bronze, Silver, Gold and Platinum -- provides you with the Essential Health Benefits that are required by the Affordable Care Act. These include:

  1. Ambulatory patient services.
  2. Emergency care.
  3. Hospitalization.
  4. Maternity & newborn services.
  5. Mental health and addiction services.
  6. Prescription drug coverage.
  7. Rehabilitative and habilitative care.
  8. Laboratory services.
  9. Preventive and wellness services, along with chronic disease management.
  10. Pediatric care, including dental and vision services.

You are entitled to health coverage with a Government Plan whether or not you have a preexisting medical condition. You also cannot be dropped by your carrier for becoming too costly to insure.

Government Plans are available only during Open Enrollment. The only exception is if you missed Open Enrollment, you could be eligible for a Government Plan if you have a Qualifying Life Event-- or certain life changes.

What are the Difference Between Government Health Plans?

The difference among plans is the cost. Each plan provides you with access to the same level of coverage. Please review the below table to compare the differences:

Plan Type Monthly / Annual Rate Subsides Accepted? Insurance Pays You Pay Best for those who:
Bronze: Low Yes 60% 40% Do not expect to regularly see the doctor or take prescriptions.
Silver: Medium Yes 70% 30% Do not expect to regularly see the doctor or take prescription drugs. However, my preference is to pay less out-of-pocket when I do need care or medication.
Gold: High Yes 80% 20% Expect to regularly see a doctor and regularly take prescription medications.
Platinum: Premium Yes 90% 10% Have an on-going medical condition or illness requiring very frequent medical services and medications.
Catastrophic:
available only for those under 30 or with a hardship exemption
Lowest No 90% 10% Meet the eligibility requirements of an income hardship and/or being under the age of 30. Coverage includes free preventive care and 3 primary care visits per year with no deductible. Entire deductible must be paid before the plan pays for catastrophic medical events.

Qualifying for a Subsidy

Subsidies are like “discounts” that are applied directly towards your health care costs. They can substantially lower the amount you pay for health coverage. You must meet certain income guidelines in order to qualify.

If you do qualify, the total amount of your subsidy will depend on your age, your household income, how many people are in your household, and whether you are a smoker.

Currently, many uninsured Americans qualify for subsidies. To learn about qualifying for subsidies, please click here.

Determining Your Eligibility

Your eligibility for Government Plans and Subsidies can be determined during the enrollment process. Please enter your zip code and fill in the 1-page application to begin.

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Please note that these numbers provided are not specific to your area but rather represent the number of organizations and the number of products available on a national basis. We will connect you with licensed insurance agents who can provide information about the number of organizations they represent and the number of products they offer in your service area.

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Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

Based on median Medicare Advantage benefit amounts for dental available across multiple plans and metro areas. Not all benefits available in specific plans or regions.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

[Benefits, premiums and/or copayments/coinsurance] may change on January 1 of each year.

Enrollment in a plan may be limited to certain times of the year unless you qualify for a special [election/enrollment] period or you are in your Medicare Initial Election Period.

Advertised Pricing:

There are several factors that impact your monthly premium; including your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

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