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Let's dig even deeper into coverage.

Now that we’ve touched on Affordable Care Act (ACA) plans, let’s get into the specifics. You’ll learn about what ACA plans cover, how to get plan savings, what metal level is for you and more. Ready? Let’s get started.

Looking for a reason to buy ACA coverage. We’ve got 10. 

ACA plans cover more than you think. Way more. Thanks to the Affordable Care Act, all ACA individual and family health insurance plans must cover these 10 essential benefit categories: 

  • Prescription drugs (including brand name and specialty drugs) 
  • Pregnancy, maternity and newborn care
  • Pediatric services, including dental and vision care 
  • Mental health and addiction services
  • Preventive, wellness and disease management services 
  • Lab tests 
  • Emergency services
  • Hospitalization
  • Ambulatory services
  • Rehabilitative and habilitative services and devices

Does that mean all ACA health plans are the same? 

While all ACA plans need to include these 10 benefits categories, the services under each category can vary by state or plan. Some insurers, like Banner|Aetna, also offer expanded services and extras to help you live healthier. You can see what each plan offers during Open Enrollment.  

You can’t judge a plan by its metal level

All ACA plans are assigned a metal tier: Platinum, Gold, Silver or Bronze. You might also hear them called “metal levels.”

At first, you might think that Gold is better than Silver. Or that Silver is better than Bronze. In fact, metal tiers don’t have anything to do with the quality of care you’ll receive. All ACA plans cover those 10 essential benefits categories. What’s different across metal levels is how the plan splits costs with you through premiums, deductibles, coinsurance and copays. 

In general, the higher a plan’s metal level, the higher your premium and the lower your out-of-pocket costs. The lower a plan’s metal level, the lower your premium and the higher your out-of-pocket costs. 

Quick guide to metal tiers and costs

Platinum

You want the lowest costs for care, even if it means the highest premium. 

Maybe you’re managing a condition or planning surgery. And you’ll take a hefty premium if the tradeoff is paying much less for care. 

You’re Platinum

  • Highest monthly premiums
  • Lowest costs when you get care 
  • Lowest deductibles
  • Can apply for premium discounts

Gold

You’re OK with paying a higher premium to keep your care costs in check.

You plan to use a lot of medical services this year. And you’d rather pay more up front to lower your costs later when you get care.  

You’re Gold

  • Higher monthly premium
  • Lower costs when you get care
  • Lower deductibles
  • Can apply for premium discounts

Silver

You want to balance your premium costs with your out-of-pocket costs.

Your premium won’t be the highest. And your costs when you get care won’t be the lowest. You’ll be somewhere safe in the middle.

You’re Silver

  • Moderate monthly premium
  • Moderate care costs 
  • Lower deductibles than Bronze plans  
  • Can apply for premium discounts and extra savings 

Bronze

You mainly want to protect yourself from worst-case health scenarios. 

You’re in good health, and you don’t need to see doctors often. But you also don’t want to break the bank if a major health issue comes up. 

You’re Bronze

  • Lowest monthly premium 
  • Highest costs when you get care
  • Highest deductibles 
  • Can apply for premium discounts 

On the marketplace or off: What’s the difference? 

With all this talk about Open Enrollment coming soon, you may be wondering how and where to shop. Let’s walk through your options. 

On the marketplace 

The Health Insurance Marketplace® (aka “the marketplace” or “the exchange”) is an online hub where you can compare and shop ACA individual and family health plans. It’s run by the federal government for many states, but the coverage is through private health plans. You can also buy these plans directly from insurers like us.

  • Who it’s great for: Anyone can shop on the marketplace. But if you qualify for premium discounts or extra savings on your out-of-pocket costs, this may be your best option. (Tip: Even if you don’t qualify for financial help, you can still shop on the marketplace.) 

Off the marketplace 

Here, you’re buying coverage outside of the official ACA marketplace. Just like on the marketplace plans, these plans cover the 10 essential benefits categories. The biggest difference? You can’t get premium discounts or extra savings if you opt for an off the marketplace plan (aka “off-exchange plan”).  

  • Who it’s great for: If you make too much money to qualify for financial help — and you’d like to explore plan options you can’t find on the marketplace — then shopping off the marketplace may be right for you. (Tip: Many people think they won’t qualify for financial help, and actually do! So be sure to check if you’re eligible.) 

Like to save? You’ll love premium discounts.

When you enroll in a plan though the Health Insurance Marketplace, you can apply for a premium tax credit (aka “subsidy”). You can use this credit to lower the cost of your monthly premium.

How to apply for a premium discount

Simply fill out a Marketplace application. You’ll provide information about your expected yearly household income and dependents. That information helps determine if you qualify for a tax credit, and the amount.

Remember: The tax credit is different for everyone. So the less you make, the bigger your premium discount. And the more you make, the lower your premium discount. 

Did you know new rules make more individuals and families eligible for savings? Check out the brochure below to learn more. 

Lower your premiums brochure – English (PDF)

Lower your premiums brochure – Spanish (PDF)

Going for a Silver plan? There’s a second way to save. 

When you fill out a marketplace application, you can also find out if you qualify for cost-sharing reductions. That’s a fancy phrase that means you can get extra savings on your deductibles, copays and insurance. So you pay less out of pocket when you get care. 

The bottom line: You have the opportunity to get premium discounts with all ACA plans: Platinum, Gold, Silver and Bronze. But you can only get premium discounts and cost-sharing reductions with Silver plans.

You can visit HealthCare.gov to check if you might be eligible for premium discounts and cost-sharing reductions before you shop. 

See if you can save

Transforming health care, together

Banner|Aetna aims to offer more efficient and effective member care at a more affordable cost. We join the right medical professionals with the right technology, so members benefit from quality, personalized health care designed to help them reach their health ambitions.

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Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner|Aetna). Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Each insurer has sole financial responsibility for its own products. Aetna and Banner Health provide certain management services to Banner|Aetna.  Aetna and CVS Pharmacy® are part of the CVS Health family of companies. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are both within the CVS Health family.

Access to the 98point6 application is included in all Banner|Aetna ACA individual & family plans. 98point6 is not available in all Banner|Aetna plans offered through employers. 98point6 is a registered trademark of 98point6 inc.

This material is for information only and is not an offer or invitation to contract. Providers are independent contractors and are not agents of Banner l Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

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