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Tips for Navigating the Health Insurance Marketplace
The Health Insurance Marketplace is meant for people who do not have health insurance coverage. This includes small business owners, those who are not covered under their spouses plan and anyone not covered by Medicaid, Medicare or TRICARE. For those who need coverage, the team at Florida-Assistance.org has compiled the following guide to help navigate the Marketplace.
Navigating the Levels of Coverage
There are levels of plans you can choose from, so before entering the Marketplace, have an idea of which level of coverage is right for you. There are Bronze, Silver, Gold, Platinum and Catastrophic levels of coverage. You pay the most on the Bronze level (40 percent, while the plan covers 60 percent) and the least on the Platinum level (10 percent, while the plan covers 90 percent). Meanwhile, with the Catastrophic level of coverage, you pay a low monthly premium at the expense of receiving less coverage.
Navigating the Types of Plans
Determine which plan is right for you by considering any preexisting conditions that require a specialist and your preferred health care provider. Here are the types of plans offered by the Marketplace:
- HMO (Health Maintenance Organization) plan: you choose a primary care physician within the plan’s network and you need a referral from your physician before seeing a specialist.
- PPO (Preferred Provider Organization) plan: you pay extra to see doctors and visit hospitals outside of your plan’s network and do not need a referral to see a specialist.
- POS (Point of Service) plan: you pay extra to see doctors and go to hospitals outside of your plan’s network, and you need a referral from your physician to see a specialist.
- EPO (Exclusive Provider Organization) plan: you can only choose doctors and hospitals that are part of your plan’s network, but you do not need a referral to see a specialist.