What is the ‘Obamacare’ Bronze Plan?

The open enrollment period begins for the new health plans created by the Affordable Care Act (a.k.a. Obamacare) on Oct. 1, yet most Americans couldn’t name one of the new health plans let alone describe all the services they cover.

The Bronze Plan is the entry-level option of these new health plans. It is a private health plan, which means you will pay an insurance company to enroll in the plan rather than receiving the plan for free from the government. However, depending on your income level, you may qualify to receive a subsidy from the government to lower your monthly premium and lower the maximum amount of health care out-of-pocket costs you can pay in a year.

The Bronze Plan is likely to be the most popular of the new plans since it is expected to have the lowest premium out of the available options. Below is a summary of what is known and not known about this new “Obamacare” plan.

Here’s what you should know

The Bronze Plan has certain factors, regardless of which insurance company you use. The most important financial facts are the percentage of costs covered by the insurance plan and the maximum out-of-pocket limit for the individual.

Plans pay for 60 percent of covered expenses for medical costs and have a $6,350 maximum limit on annual out-of-pocket costs in 2014.

For those enrollees whose out-of-pocket costs reach that limit, they will not pay any additional costs for covered medical services during the remainder of the calendar year.

The Bronze Plans also have some level of insurance coverage in each of the following categories:

* Ambulatory services (e.g. primary care doctor visits)
* Emergency services
* Hospitalization
* Maternity and newborn care
* Mental health services and substance use disorder services
* Prescription drug coverage
* Rehabilitative and habilitative services
* Laboratory tests
* Preventive and wellness services
* Pediatric services (including both oral care and vision care)

Employees of a small business purchasing Bronze Plans in 2014 can have a maximum deductible of $2,000 while employees with family coverage can have a maximum deductible of $4,000.

Questions that still need to be answered

Industry pundits as well as consumers still don’t know what the actual insurance premiums will be for these plans. Some industry insiders expect significant premium increases partly due to extensive mandatory benefits for the plans and partly due to the fact that insurers will have to insure more sickly individuals who were often rejected previously due to pre-existing medical conditions. Some other insiders expect premiums to be comparable to existing premiums due to profit limitations on health plans.

Another question is how the 40 percent of medical expenses paid will translate into deductibles, co-payments, and coinsurance across the various medical services covered by the plan.

The networks of health care providers offered by Bronze Plans are another mystery. Some experts predict that these plans will be more likely than current plans to use a “narrow network,” i.e. a smaller collection of doctors, hospitals, and other health care providers. Narrow networks enable insurers to better control the health care costs of their enrollees but they may result in some consumers finding it more difficult to find a plan in which their current doctor participates.

Getting answers sooner than later

Some of the outstanding questions about Bronze Plans won’t be answered until the plans are available this October during open enrollment. However, states may shed some light on cost-sharing designs prior to October if they enact regulations regarding limits on deductibles and other fees charged by health plans in their states.

For more information on Bronze Plans, visit HealthPocket.com.

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