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Missouri's Health Insurance Marketplace Toolkit

Marketplace Basics

From October 1, 2013 to March 1, 2014, private insurance companies will offer insurance policies for sale in the Marketplace. But only federally-certified “Qualified Health Plans” (QHP) will be allowed. Every QHP is required to cover the same core of comprehensive essential health benefits, including doctor visits, emergency care, hospitalization, preventive care, vision and dental care, prescription drugs, and more, and there cannot be higher costs or denial of coverage for pre-existing health conditions. This will allow the Marketplace to offer an “apples to apples” presentation with which consumers can more easily compare plans based on price, benefits, and whether or not their physician is in the plan’s provider network.

Four levels of health plans will be available in the Marketplace, but all must include the core essential benefits. The levels are:

Bronze - These plans pay 60 percent of medical expenses.
Silver - These plans pay 70 percent of medical expenses.
Gold - These plans pay 80 percent of medical expenses.
Platinum - These plans pay 90 percent of medical expenses.

Certain low and middle-income individuals and families might be eligible for a federal tax credit to help pay for their premiums. The calculation is complicated and varies depending upon income and the amount of coverage purchased, but in general terms those with household income from 100% to 400% of the federal poverty level might be eligible for that subsidy. Only by filling out a Marketplace insurance application can a person get an official estimate.

Also, some low-income individuals and families might be entitled to lower copayments, deductibles, and co-insurance obligations. Every insurance company selling QHPs in the Marketplace must limit out-of-pocket costs to low-income households. Like the premium tax credit, this depends upon income and the type of coverage purchased. And like the premium tax credit, the best way to get an estimate is to fill out the Marketplace application.


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Contact MSMA or call 800-869-6762 for more information.

 

 
         
 

 

 

 

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