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
- Gold, and
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:
- Ambulatory patient services.
- Emergency care.
- Maternity & newborn services.
- Mental health and addiction services.
- Prescription drug coverage.
- Rehabilitative and habilitative care.
- Laboratory services.
- Preventive and wellness services, along with chronic disease management.
- 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.|
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, or call (800)-414-8940 to speak to an agent.