Using the Healthcare Marketplace and Saving Money on Insurance

The Health Insurance Marketplace® can seem overwhelming, but we are going to help you through the insurance coverage enrollment process and everything you need to know about saving money on your health insurance.

We’ll walk you through how to use healthcare.gov, review healthcare marketplace options, give tips on how to compare health plans, provide health insurance comparisons, explain what an insurance tax credit is, and help you and your family get covered.

About the Healthcare Marketplace

The Health Insurance Marketplace® (also known as the “Marketplace” or “exchange”) is a service by the federal government that helps people shop for and enroll in health insurance. In Kansas, there is a network of Health Navigators across the state who can help you — free of cost — review health plans, get enrolled, provide assistance in using the healthcare marketplace, and show you how to use healthcare.gov.

Small businesses can use the Small Business Health Options Program (SHOP) Marketplace to provide health insurance for their employees.

We’ve also created a comprehensive health insurance guide on how to get affordable health insurance in Kansas, help with marketplace insurance, and health insurance navigator resources.

Understanding Health Insurance Options

There are 4 categories of health insurance options (referred to as “metal categories”):

• Bronze
• Silver
• Gold
• Platinum

These categories show how you and your insurance provider share costs.

Plan Category	The insurance company pays	You pay
Bronze	60%	40%
Silver	70%	30%
Gold	80%	20%
Platinum	90%	10%

Please note that these categories of plans have nothing to do with the quality of care.

You pay a monthly bill to your insurance company (a “premium”), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.

• BRONZE
  • Bronze health plans have the lowest monthly premium and the highest costs when you need care.
  • Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.
  • Bronze plans are a good choice if you want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
• SILVER
  • Silver health plans have a moderate monthly premium and moderate costs when you need care.
  • Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.
  • Silver plans are a good choice if you qualify for “extra savings,” or if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
• GOLD
  • Gold health plans have a high monthly premium and low costs when you need care.
  • Gold deductibles — the costs you pay yourself before your plan pays anything — are usually lower than bronze or silver plans.
  • Gold plans are a good choice if you’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.
• PLATINUM
  • Platinum health plans have the highest monthly premium and lowest costs when you need care.
  • Platinum deductibles — the costs you pay yourself before your plan pays anything — are usually lower than bronze, silver, or gold plans.
  • Platinum plans are a good choice if you usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.

Within these four categories, there are different types of plans, such as:

• Exclusive Provider Organization (EPO)
  • A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
• Health Maintenance Organization (HMO)
  • A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
• Point of Service (POS)
  • A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
• Preferred Provider Organization (PPO)
  • A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

It is important to note that some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.

Saving Money with a Premium Tax Credit

Saving money on health insurance can happen in a few ways. Healthcare.gov provides a tool to see if your income estimate falls in the range for an insurance tax credit (called a “premium tax credit”) and cost-sharing reductions. The type of savings you qualify for may affect which plan category is the best fit for you.

When using the saving estimate tool, there are a few basic things you will need to provide in order to find out how much of a tax credit you can receive for your health insurance.

• The state you live in.
  • Count yourself, your spouse if you’re married, plus everyone you’ll claim as a tax dependent, including those who don’t need coverage.
• The number of people in your household.
  • Count yourself, your spouse if you’re married, plus everyone you’ll claim as a tax dependent, including those who don’t need coverage.
• Estimated household income for the year.

Want to see how much you can save on your health insurance with a premium tax credit? Click the button below to find out.

When you buy health insurance through the Marketplace, you may also qualify for financial assistance to help pay your monthly premiums.

You will qualify for financial assistance if you meet the following:

• You can’t get health insurance that covers your basic needs through any of the following: your job (or a family member’s); Medicaid; Medicare; the Children’s Health Insurance Program (CHIP); or the Department of Veterans Affairs (the VA).
• The amount of money your family expects to make in the year you apply for assistance falls within the amounts shown in the table below.

Number In Household	Income Range
Individual	$12,880 – $51,520
Family of 2	$17,420 – $69,680
Family of 3	$21,960 – $87,840
Family of 4	$26,500 – $106,000
Family of 5	$31,040 – $124,160
Family of 6	$35,580 – $142,320

Selecting a Health Insurance Plan

How to compare health plans? This is often the most confusing part of health insurance. There are numerous types of plans as you know if you read the section on “Understanding Health Insurance Options.” Cover Kansas is here to help you in the process of health insurance comparisons and selecting the plan that best meets your needs for insurance coverage.

If you would like to browse current health plans before talking to a health insurance expert (called a “Health Navigator”), visit healthcare.gov/see-plans and enter your zip code to see plans and prices. There are 123 total plans available in Kansas for 2022. We’ve gathered them into a document to help, and you can see all the 2022 Kansas Insurance Plans Brief (PDF) by downloading it.

What Determines Your Healthcare Plan Costs?

When choosing a plan, it’s a good idea to think about your total health care costs, not just the bill (the “premium”) you pay to your insurance company every month.

Other amounts, sometimes called “out-of-pocket” costs, have a big impact on your total spending on health care – sometimes more than the premium itself. It is important to understand deductibles, copayments, coinsurance, and out-of-pocket maximums when estimating your annual costs of care.

Beyond your monthly premium: Deductible and out-of-pocket costs

• Deductible
  • How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)
• Copayments and Coinsurance
  • Payments you make each time you get a medical service after reaching your deductible
• Out-of-Pocket Maximum
  • The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

How to estimate your yearly total costs of care

In order to pick a health insurance plan based on your total costs of care, you’ll need to estimate the medical services you’re likely to use for the year ahead. Of course, it’s impossible to predict the exact amount. So think about how much care you usually use, or are likely to use.

When you view plans, you’ll see an estimate of your total costs — including monthly premiums and all out-of-pocket costs — based on your household’s expected use of care. You can choose each family member’s expected medical use as low, medium, or high when shopping on the Marketplace.

Your actual expenses will vary, but the estimate is useful for comparing plans’ total impact on your household budget.

Total Costs & “Metal” Categories

When you compare plans in the Marketplace, the plans appear in 4 “metal” categories: Bronze, Silver, Gold, and Platinum. The categories are based on how you and the health plan share the total costs of your care.

Generally speaking, categories with higher premiums (Gold, Platinum) pay more of your total costs of health care. Categories with lower premiums (Bronze, Silver) pay less of your total costs. (But see the exception about Silver plans below.)

So how do you find a category that works for you?

• If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.
• If you qualify for “cost-sharing reductions” (CSRs), Silver Plans may offer good value. If you qualify, your deductible will be lower and you’ll pay less each time you get care. But you get these extra savings only if you enroll in Silver. If you don’t qualify for CSRs, compare premiums and out-of-pocket costs of Silver and Gold prices to find the right plan for you. See if your income estimate falls in the range for cost-sharing reductions.
• If you expect a lot of doctor visits or need regular prescriptions, you may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.

How Cover Kansas Can Help

Cover Kansas Navigators are trained, unbiased individuals that can help you compare health insurance plans, assist you with the online application process, and provide answers to your Marketplace questions year-round.

The Cover Kansas website answers any questions you might have about enrolling and allows you to get free assistance from a certified Navigator.

You can also read our “Health Care Coverage Guide” to learn more.

Getting coverage through the federal Health Insurance Marketplace can be a complicated process. We have simplified it. Call 866-626-8357 or click “Find a Navigator” today to speak with a member of our team for free.