This article explains the costs of health care plans offered under the Affordable Care Act (commonly called Obamacare) for individuals or families who are currently uninsured or not covered by a job-based health plan.
What you'll pay for an Obamacare plan depends on five things:
- The level of coverage you choose
- Whether you qualify for a subsidy
- Where you live in North Carolina
- Your age
- Whether you smoke
Read on to learn more about each of these factors.
1. The Level of Coverage You Choose
Obamacare insurance plans offer four levels of coverage, commonly called "metal levels":
Platinum -- covers approximately 90% of health care costs
Gold -- covers approximately 80% of health care costs
Silver -- covers approximately 70% of health care costs
Bronze –- covers approximately 60% of health care costs
Bronze plans carry the lowest monthly premiums, but you will pay the highest out-of-pocket costs for health care services. Platinum premiums are highest, but additional expenses will be lower than with other plans.
All four categories offer the same essential benefits, including hospitalizations, prescription drugs, maternity care, and more. The categories should not affect type or quality of care you will receive.
Catastrophic plans. In addition to the categories above, if you are under the age of 30, you can purchase a “catastrophic” insurance plan at a lower cost than a bronze plan. These plans don’t qualify for the premium discounts discussed below. Under a catastrophic plan, you will probably have to pay all of your medical costs up to a certain amount, perhaps several thousand dollars. After that, the costs of essential health care benefits are paid by insurance.
2. Whether You Qualify for a Subsidy
Depending on your income and the size of your family, you may be able to reduce the costs of Obamacare insurance in one of the following ways:
Lower monthly premiums. You can lower the cost of your monthly premiums if you qualify for a tax credit. The credits can be applied directly to your monthly premiums, so you save money right away.
Reduce out-of-pocket costs. If you meet the eligibility requirements, the total amount of your annual out-of-pocket costs -- such as deductibles and copays -- will be reduced.
Obtain coverage under Medicaid or the Children’s Health Insurance Program (CHIP). Low-income individuals and families may qualify for free or low-cost health care coverage through one of these programs, instead of Obamacare.
For details about these subsidies and to learn more about whether you qualify, see Ways to Save Money on Obamacare in North Carolina.
3. Where You Live in North Carolina
In most states, premiums vary depending on where you live.
4. Your Age
Under Obamacare, health plans must allow you to enroll regardless of your age, but the costs of your plan will most likely depend, in part, on how old you are.
5. Whether You Smoke
The Affordable Care Act allows insurance companies to charge people who use tobacco up to 50% more in monthly premiums than those who do not. (The average additional cost is about 20%.) In addition, subsidies can’t be used to cover any portion of the tobacco surcharge added to the monthly premium.
You can learn the final costs for specific plans, including whether you qualify for subsidies or low-cost care programs, by applying for insurance online at Healthcare.gov.