Question: If I’m shopping on my own, with no workplace coverage, will I be able to find decent health insurance? Answer: Your chances of that should improve significantly when the new law is fully in effect.
Got questions about the Affordable Care Act? In a regular feature, the WHYY/NewsWorks Health and Science Desk is providing “The Short Answer.”
If I’m shopping on my own, with no workplace coverage, will I be able to find decent health insurance?
The short answer
Your chances of that should improve significantly when the new law is fully in effect.
Under the Affordable Care Act, every plan sold in the individual and small-group markets has to offer a package of essential health benefits.
Going forward, the government has decided on 10 categories of care that must be covered, including emergency room visits, prescription drugs and rehabilitation. The new rule is for health plans that are offered both inside and outside of the new health insurance marketplaces set to operate in each state.
This essential benefits rule pushes health insurance companies to offer plans that better resemble the coverage most Americans get at work (sometimes called employer-sponsored plans).
With minimum health benefits held somewhat constant, shoppers will be able to focus more on the costs associated with the plan they are purchasing.
A new tiered rating system for plans — bronze, silver, gold, and platinum — aims to help consumers figure out how much protection an insurance plan really offers versus the medical expenses they will shoulder on their own. There are several questions consumers should consider before choosing a plan.
For bronze plans, 60 percent of average medical costs will be paid by the insurance company, which means enrollees pay about 40 percent of medical expenses out of pocket. Platinum plans will have the most generous benefits: 90 percent of average medical costs will be covered.