Transitioning to a Marketplace Qualified Health Plan

All health insurance plans must cover certain benefits. These benefits are known as care components. To help you understand and compare health insurance plans, it’s important to understand what a care component is, and what it means for you. What Are Marketplace Qualified Health Plans? 

The federal government has set minimum standards for most of the essential health benefits that every Qualified Health Plan must cover, including hospitalization, mental health treatment (including behavioral health treatment), primary care services, prescription drugs, emergency services, ambulatory care services, and medically-necessary childhood immunizations. This means that if you want to shop for an affordable health plan in the marketplace or change your current plan to something more affordable later this year when the new plans take effect, you should definitely look into a Qualified Health Plan (QHP). Qualified Health Plans are more affordable than other types of health insurance because they have lower premiums and/or lower out-of-pocket costs like deductibles. 

Pros of Marketplace Qualified Health Plans

To learn about the benefits of marketplace qualified health plans, you should know what type of plan you’re looking for. There are three types of marketplace plans: bronze, silver, and gold. Each level has a different deductible, coinsurance amount, and out-of-pocket maximum amount. If you want to get the most out of your plan, it’s best to check each level of coverage to see which one is right for you. Bronze plans have a $7,500 annual deductible and 20 percent coinsurance with no year limit on how long people can stay on the plan. Silver plans have a $1,300 annual deductible with 30 percent coinsurance with no year limit on how long people can stay on the plan. Gold plans have a $750 annual deductible with 40 percent coinsurance with no year limit on how long people can stay on the plan. There are also two levels of catastrophic coverage available in the marketplace: bronze and platinum. Bronze covers 70 percent of eligible medical costs while platinum covers 80% of eligible medical costs. 

What Are the Benefits of a Marketplace Qualified Health Plan?

The benefits of a Marketplace Qualified Health Plan (QHP) are that you pay less for your health insurance because it covers more care components. If you were to switch to a Marketplace QHP, you would avoid the cost of being uninsured on the days when you don’t actually need to go to the doctor or hospital. You also won’t have any out-of-pocket costs associated with routine services like doctor visits and prescription drugs. This is because the QHP will cover them all. You could also save money by switching to a Marketplace QHP because these plans usually have lower premiums than private insurance plans and other types of health insurance.

Cons of Marketplace Qualified Health Plans

There are some important things to consider before switching to a Marketplace Qualified Health Plan. You may not be able to switch your plan or keep your current plan if you have a pre-existing condition if you are planning on having any type of surgery or hospitalization soon, if you have a history of chronic health problems or life-threatening conditions, or if you don’t live in the U.S. You also need to know that because QHPs offer lower premiums and/or lower out-of-pocket costs like deductibles, they usually come with higher co-pays for services and prescriptions as well as different benefits for certain medications. So there is no guarantee that what you’re currently getting will remain the same when it comes time to switch from one plan to another. Additionally, QHPs have limited choices for providers--you can only use doctors who are in their network. Another thing to consider is the fact that QHPs don’t cover all of the care components that all other types of health insurance plans do (like hospitalization and prescription drugs). However, QHPs typically cover more services than other types of plans which helps make them more affordable. 

Bottom Line

There are some important things to consider before switching to a Marketplace Qualified Health Plan. You may not be able to switch your plan or keep your current plan if you have a pre-existing condition if you are planning on having any type of surgery or hospitalization soon, if you have a history of chronic health problems or life-threatening conditions, or if you don’t live in the U.S. You also need to know that because QHPs offer lower premiums and/or lower out-of-pocket costs like deductibles, they usually come with higher co-pays for services and prescriptions as well as different benefits for certain medications. So there is no guarantee that what you’re currently getting will remain the same when it comes time to switch from one plan to another. Additionally, QHPs have limited choices for providers--you can only use doctors who are in their network. Another thing to consider is the fact that QHPs don’t cover all of the care components that all other types of health insurance plans do (like hospitalization and prescription drugs). However, QHPs typically cover more services than other types of plans which helps make them more affordable.