Exploring Marketplace Myths For Clients

In terms of costs, platinum plans provide 90/10 coverage—with the plan covering 90 percent of costs and the user paying 10 percent. This is better than many employer-based  plans. So if your client qualifies for tax credits, they can apply them to any plan on the Marketplace. This may allow them to purchase a high-level plan with a lower premium. It’s important to note that 90/10 doesn’t necessarily mean coverage costs breakdown exactly at 10 percent for the consumer. Instead, the platinum plan covers an estimated 90 percent of all medical expenses after deductibles; co-pays and other out-of-pocket costs are incorporated.

Consumers have on average three or more health insurers offering plans in their state, according to Kaiser’s analysis of 2016 Marketplaces. As with any purchasing decision, your clients could benefit from shopping the exchange in their area because premiums, provisions and provider networks can vary significantly among healthcare plans.

Marketplace Plan Types – The Basics

Platinum – 90/10: 90 percent plan coverage, 10 percent out-of-pocket

Gold – 80/20: 80 percent plan coverage, 20 percent out-of-pocket

Silver – 70/30: 70 percent plan coverage, 30 percent out-of-pocket

Bronze – 60/40: 60 percent plan coverage, 40 percent out-of-pocket

Catastrophic: Under age 30 only or hardship coverage

3. The Marketplace is only for those who can’t get insurance anywhere else. This is one of those myths that doesn’t appear to be harmful, but it can be costly. For example, although the ACA’s intent was to provide health insurance to people uninsured, because of pre-existing conditions or employers who didn’t provide coverage, millions of people are eligible to shop the Marketplace. This includes individuals whose employer coverage is extremely pricey compared to their salary. It’s also clear that the Marketplace offers alternatives to workers who would like to retire but are continuing to work to ensure their spouse and dependents have health-care coverage, or because they are waiting to reach age 65 and Medicare eligibility.