Affordable Care Act will offer bronze, silver, gold, platinum plans and some catastrophic plans

Family of 4 in WPB making $50,000 to pay $18/mo

WEST PALM BEACH, Fla. - Patients with health issues will no longer be priced out of the insurance market.  We don't know the exact prices for plans offered through the Health Insurance Marketplace , but rates will be based on your zip code, age, and smoking status. Sorry smokers, you may pay more.

"I'm just a single man remodeling," said contractor Rick Smith.

Smith is back in business fixing homes after sitting in his own home unemployed and uninsured since the housing slowdown a few years ago. Smith started his own remodeling company, Quality Home Team.

"We have a $56,000 hospital bill we can't pay," said his wife Debbie Smith.

Smith still doesn't have insurance. Starting October 1, he can sign up for coverage through the Health Insurance Marketplace .

"We are going to start looking so we get educated on it and know our options and which way to go," said Rick.

Think of the plans like the Olympics

Most people will choose among a bronze, silver, gold, or platinum plan. Think of it like the Olympics. A gold medal is better than a bronze medal.

"The richer plans have lower co-pays, lower deductible, or lower out of pocket costs," said Plastridge insurance broker Joshua Dorman.

He says there will be a series of plans offered with each metal level. In Palm Beach County, the silver plan offers the most choices.

According to the state, there are 28 silver plans, 26 bronze, 21 gold, and 11 platinum choices.

"Obviously if you know you will have more claims or you want a larger network, you may have to pick a richer plan so you know you'll have less costs out of pocket," Dorman explained.

There is a catastrophic plan for people under 30, but there are limitations.

When you sign up for coverage through Healthcare.gov, you will see these plans if you qualify.

If you are under 30 and have a limited income, you may be able to buy a catastrophic health plan so you are not faced with very high medical costs. These are available when other insurance is not considered affordable or you received a hardship exemption.

With this plan, you will pay all costs up to a certain amount. The government said that threshold is usually several thousand dollars. You'll have lower premiums, but you may only get coverage in a worst-case situation where you have a lot of medical needs.

Essential health benefits are typically paid by the company. You also get 3 primary care visits at no cost each year. Free preventative benefits are also included.

If you qualify, you'll see the catastrophic plans when you sign up for coverage through the Health Insurance Marketplace .

Prices

The government released some prices today, specific to West Palm Beach. For a family of four making $50,000, a bronze plan will cost $18 a month with a tax credit. For a 27-year old making $25,000 a year, $72 will be the cost of the bronze plan and $145 for the silver plan with tax credits.

Think of it like jewelry. Platinum platinum costs more than silver, but you'll get a better product.

The plans will cover a certain actuarial value of your health costs. For example, the bronze plan will cover 60% of your actuarial costs, silver 70% actuarial, gold 80% actuarial, and platinum 90% actuarial.

"It's not 60% of the plan. So if I go to the hospital and have a million dollar bill, I'm not going to be responsible for 40% of it. It means as you use the plan, over the year, 60% of it will be covered by the plan and 40% of it is covered by you. Obviously, as you have larger claims the number drastically reduces," Dorman explained.

Don't forget there are caps for these plans, so the most anyone will pay out of pocket on an Affordable Care Act Plan is $6,350 for an individual and $12,700 for a family.

The government will also offer subsidies and tax breaks for those who qualify.

You can answer a few questions now, and figure out if you qualify for a subsidy or tax break .

The Smith's hope they finally get the financial break they've been waiting for.

"Affordability and major medical coverage," Debbie said.

"There are things I don't do anymore because of the chance of getting hurt," said Rick.


 

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