Benefits (Medical service or supply)

What are Benefits

In the world of health insurance, benefits refer to any medical service or supply covered by your health insurance plan. These include doctor visits, hospitalizations, and medications.  An outline of what your benefits will and won’t cover can be found in you health insurance plan’s coverage documents.  Coverage documents outline and explain your benefits, accessing health care, and much more.  

There are so many providers out there, and each provider offers different plans at different levels and costs. Before you make any final decisions, make sure that you understand these basic facts about health insurance plans.

What Are Essential Benefits?

Essential benefits are a set of 10 basic medical service categories that health insurance plans must cover. Some plans may offer more services, and there may be variations based on individual state's requirements.

10 Essential Marketplace Benefits

list of essential benefits


What Are the Benefit Levels?

When selecting your insurance plan, there are generally five benefit levels of insurance, also known as metal levels, you can choose from: Bronze, Silver, Gold, Platinum, and Catastrophic.  It’s important to note that these benefit levels do not affect the quality of care you will receive, but rather the how medical costs will be split between you and your insurance plan. 

How Do Benefit Levels Affect Your Out-of-Pocket Costs

The benefit level you choose determines what your premium will be.  In short, your premium is the amount you pay for your insurance plan, typically paid in monthly installments.  Usually, the higher the premium, the smaller your out-of-pocket costs will be, and vice versa.

For example, a Bronze insurance plan will cost you the least in terms of monthly payments, but you will pay more to your provider at the time of service. The average out-of-pocket payment at time of service for a Bronze plan holder is 40%.

A Platinum plan holder will typically pay a larger monthly premium, but their out-of-pocket payment at the time of service will be about 10%.

The Catastrophic plan is the most basic plan available. It is generally chosen by those who are only looking for the minimal amount of coverage or who simply wish to avoid the tax penalty that comes with not having any insurance at all.

These are only a few of the many factors that go into choosing the best health insurance plan to fit your needs. To learn more, give us a call at 858-771-4087 or enter your zip code for free health insurance quotes.