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SELECCIONAR UN PLAN DE ATENCIÓN MÉDICA


La línea de ayuda del Mercado de Seguros de Salud (Marketplace) de Delaware


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SELECCIONAR UN PLAN DE ATENCIÓN MÉDICA


Elegir un plan de seguro de salud puede ser complejo. Saber algunas cosas antes de comparar planes puede simplificar la tarea.


1) Existen 4 CATEGORÍAS de planes de seguro de salud que tienen nombres de metales: Bronce, Plata, Oro y Platino. Estas categorías se basan en cómo usted y su plan dividen los costos de su atención médica. No tienen nada que ver con la calidad de la atención. Los planes de todas las categorías proporcionan atención preventiva, y algunos ofrecen servicios gratis o con descuentos antes de alcanzar su deducible.

Independientemente de la categoría de metal que elija, puede ahorrar mucho dinero en su prima mensual de acuerdo a sus ingresos. Cuando complete la solicitud del Mercado de Seguros de Salud (Marketplace), sabrá si califica para estos ahorros. Se aprobó otra nueva ley, llamada Ley de Reducción de la Inflación, para aumentar la asistencia financiera. El año pasado en Delaware, nueve de cada diez personas recibieron asistencia financiera y pagaron menos de $10 por mes.

BRONZE

Plan Category

60%

How much the INSURANCE COMPANY Pays




40%

How Much YOU Pay




Lowest monthly premium

Highest costs when you need care

Highest deductibles (can be thousands of dollars)

Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.

SILVER

Plan Category

70%

How much the INSURANCE COMPANY Pays




30%

How Much YOU Pay




Moderate monthly premium

Moderate costs when you need care

Lower deductibles than Bronze plans

Good choice if: You qualify for “extra savings” or you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.

IMPORTANT: If you qualify for cost-sharing reductions you must pick a Silver plan to get the extra savings.

GOLD

Plan Category

80%

How much the INSURANCE COMPANY Pays




20%

How Much YOU Pay




High monthly premium

Low costs when you need care

Low deductibles

Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.

PLATINUM

Plan Category

90%

How much the INSURANCE COMPANY Pays




10%

How Much YOU Pay




Highest monthly premium

Lowest costs when you get care

Very low deductibles

Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.

 

2) There are different TYPES of health insurance plans and each is designed to meet different needs. Some types restrict the providers you can see or where you can go to get care, while others pay a greater share of costs for providers outside the plan’s network:

  • Health Maintenance Organization (HMO) - usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.
  • Preferred Provider Organization (PPO) - you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
  • Point of Service (POS) - you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
  • Exclusive Provider Organization (EPO) - services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

 

3) Catastrophic health insurance plans are only available to people under the age of 30 or people of any age with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable). If you are eligible for a Catastrophic plan, you will see them displayed when you compare plans in the Marketplace.

Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from serious health conditions or injuries, but you pay for most of the routine medical expenses yourself. Catastrophic plans cover essential health benefits, certain preventive services at no cost and at least 3 primary care visits per year without meeting the deductible; however, the insurance company will not pay for all covered services until you meet your deductible.

 

DELAWARE MARKETPLACE HEALTH CARE PLANS

más opciones disponibles


Debe presentar su solicitud antes del 15 de diciembre de 2022, durante el Período de inscripción abierta, para obtener la cobertura que comenzará el 1 de enero de 2023. Si presenta la solicitud entre el 16 de diciembre de 2022 y el 15 de enero de 2023, su cobertura comenzará el 1 de febrero, 2023. Los residentes de Delaware que busquen cobertura para 2023 tendrán más opciones que nunca. Treinta planes de atención médica están siendo ofrecidos por 3 compañías de seguros:

  • Highmark Blue Cross Blue Shield ofrecerá 17 planes (4 bronce, 3 plata, 6 oro, 3 platino, 1 catastrófico)
  • Aetna CVS Health ofrecerá 9 planes (3 bronce, 4 plata, 2 oro)
  • Amerihealth Caritas ofrecerá 4 planes (2 bronce, 1 plata, 1 oro)

Dos aseguradoras dentales (Delta Dental of Delaware, Inc. y Dominion Dental Services, Inc.) también ofrecerán trece planes dentales independientes. El personal capacitado de Quality Insights lo ayudará a revisar sus opciones para que pueda seleccionar el plan que mejor se adapte a sus necesidades y/o las de su familia.

It’s important to know if you are eligible for a premium tax credit or if your income qualifies for extra savings known as cost-sharing reductions. You will learn if you are eligible for either of these when you fill out a Marketplace application. The premium tax credit can lower your monthly health insurance premium bill and the cost-sharing reduction will save you money by paying less out of your pocket each time you get medical services.

Quality Insights Navigators are available NOW to walk you through the application and plan selection process so you can decide which plan best meets your needs. Call us at 1-844-238-1189 when you are ready to compare plans and prices or if you need help submitting a Marketplace application.

 

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Quality Insights ofrece educación gratis y asistencia práctica a los consumidores del Marketplace de atención médica federal en Delaware.

 

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