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Arkansas Individual plans are separated into four categories — Bronze, Expanded Bronze, Silver, and Gold. The "metal levels" indicate the average percentage the insurance company pays for covered medical services. The percentages on average that each metal level plan will pay are: Bronze, 60 percent (with a -4/+2 range); Expanded Bronze, 60 percent (with a -4/+5 range); Silver, 70 percent (with a -4/+2 range); and Gold, 80 percent (with a -4/+2 range). The consumer pays the difference up to a maximum out-of-pocket limit. Money spent by the consumer on monthly premiums is not included in the calculation for determining the metal level of a plan.
Individual plans will be available in the Marketplace for comparison and purchase during open enrollment period between November 1 and Janurary 15 at www.healthcare.gov or by calling 1-800-318-2596 (24 hours a day, 7 days a week).
How to Use the Plan Comparison Chart Using the downloaded Plan Comparison chart, you can view insurance plans available in your area and compare them by what you will pay and by services (benefits) so you can choose the plan that best meets your budget and healthcare needs. The insurance company and plan name are listed across the top of each page, and the plan benefits are listed down the left hand side. Benefits are grouped by category, such as "Office Visits and Outpatient Services" or "Pharmacy."
General information about the plans is on the first page:
To compare the plans that interest you, scroll down to find a benefit or service you think you may use on the left. Each service has two lines: "In Network" and "Out of Network" which tells you whether the provider is in the company's network of preferred providers. Looking across the page you can see the differences in the amount you would pay. Using “In Network” services is usually less expensive than using "Out of Network" services.
| Deductible |
The amount you owe for health care services before your health insurance begins to pay. For example,
if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for
covered health care services subject to the deductible. The deductible may not apply to all services.
|
| Copay |
A fixed amount you pay each time you use a service
|
| Coinsurance |
Coinsurance is your percentage (%) of the payment for medical service(s). For example, if the
table shows 20% coinsurance for a medical service, you pay 20% toward the charges and the insurance
company pays 80%.
|
| Maximum Out Of Pocket (MOOP) |
This is the maximum amount you or your family would pay for medical services within a year. You will
neither have to pay copay nor coinsurance after you reach this limit.
|
| Not Covered |
You will always be responsible for 100% of the cost of the service.
|
| No Charge |
You will never be responsible for any of the cost of the service.
|