Plans in the Marketplace are separated into categories — Bronze, Silver, Gold, or Platinum — based on the amount of cost sharing they require. Cost sharing refers to health plan deductibles, copays, and coinsurance. For most covered services, you will have to pay some of the cost, at least until you reach the annual out-of-pocket limit on cost sharing. Preventive health services, however, are covered without cost-sharing. In the Marketplace, Bronze plans have the highest…

Although all Marketplace health plans are required to cover the ten categories of essential health benefits, insurers in many states have flexibility to modify coverage for some of the specific services within each category, subject to approval by their Marketplace. All health plans must provide consumers with a Summary of Benefits and Coverage (SBC) to make it easier to compare differences in health plan benefits and cost sharing. It is also available for each plan…

All qualified health plans offered in the Marketplace cover the "essential health benefits" (EHB), including: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain…

All health plans offered through the Marketplace must meet the requirements of “qualified health plans.” This means they will cover essential health benefits, limit the amount of cost sharing (such as deductibles and co-pays) for covered benefits, cover certain preventive services at no cost to consumers, and satisfy all other consumer protections required under the Affordable Care Act. Health plans vary in the benefits they cover and the level of cost sharing required. Plans are…