Selecting a Health Care Plan
Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.
1) There are 4 CATEGORIES of health insurance plans and they are named after metals: Bronze, Silver, Gold, and Platinum. These categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care. Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible.
No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income. When you fill out a Marketplace application, you’ll find out if you qualify for these savings. This year, a new law called the American Rescue Plan provides greatly improved financial assistance, which can significantly lower people’s monthly payments right away. Some people will also qualify for help paying their co-pays and deductibles. Four out of five people can find a plan for $10 or less per month with the newly expanded financial assistance.
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. In 2020, the deductible was $8,150.
Delaware Marketplace Health Care Plans
As of March 1, 2022, 12 Preferred Provider Organization (PPO) health care plans were listed on the healthcare.gov website for residents of Delaware. All plans are offered through Highmark Blue Cross Blue Shield Delaware. The plans include 3 Bronze, 3 Silver, 4 Gold, and 2 Platinum plans.
Bronze
my Blue Access PPO Bronze 3800
my Blue Access PPO Bronze 6900 HSA
my Blue Access PPO Bronze 3800 + Adult Dental and Vision

Silver
my Blue Access PPO Silver 3250 HSA
my Blue Access PPO Silver 2900
my Blue Access PPO Silver 2900 + Adult Dental and Vision

Gold
my Blue Access PPO Gold 0
my Blue Access PPO Premier Gold 0
my Blue Access PPO Gold 0 + Adult Dental and Vision
my Blue Access PPO Premier Gold 0 + Adult Dental and Vision

Platinum
my Blue Access PPO Platinum 0
my Blue Access PPO Platinum 0 + Adult Dental and Vision

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.
The American Rescue Plan passed this year provides more financial assistance than previous years, allowing four out of five people to find a plan for $10 or less per month.
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.