About Insuring Your Health
KHN contributing columnist Michelle Andrews writes the series , which explores health care coverage and costs.
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Q: How many choices will consumers have in a marketplace? Will PPOs and HMOs be included?
A: The number of plans that consumers will have to choose from is likely to vary widely. In some states, only a couple of insurers have announced plans to offer policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. You can expect that insurers will offer a variety of types of plans, including familiar models like PPOs and HMOs.
There will be some important differences, however. All of the plans sold on the exchanges will offer a similar package of 10 essential health benefits that provide comprehensive coverage. How much consumers will owe in cost sharing will vary depending on which of four types of plan they choose.
In a platinum plan, the most generous plan offered, the insurer will pay 90 percent of covered medical expenses and the consumer will be responsible for 10 percent, on average. In a gold plan, the insurer will pay 80 percent and the consumer 20 percent. Silver plans will pay 70 percent and bronze plans 60 percent.
There will also be a high deductible catastrophic plan that’s available to people up to age 30. It will cover only limited benefits before the deductible is met.
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