Healthcare Plans

Comparing plans made easier

Metallic Values

Health care reform makes it easier to compare health insurance plans. These metallic levels (bronze, silver, gold and platinum) have been established to indicate the value of coverage in a plan. This allows you to easily compare plans with different deductibles, copayments and coinsurance requirements and determine which plan works best for you.

But keep in mind that the metallic values don’t reflect some factors that may be important to you, such as:

  • The number of doctors and hospitals in the plan’s network
  • Requirements for receiving benefits, such as prior approval for certain medical services
  • The plan’s health and wellness programs

metallicAll new health insurance plans offered in the individual market must fall within these metallic levels, except for catastrophic plans. Catastrophic plans may be a good value if you don’t expect to have many medical expenses. Individuals must be under 30 or qualify based on a hardship exemption as defined by the federal government. For details, contact Synergy Benefit Advisors.

Health insurance coverage is guaranteed available in North Carolina. An insurer may not refuse to issue coverage to an individual or charge an individual more premiums because of their health status or any pre-existing conditions. Premium assistance is available for qualifying individuals for plans purchased through the federal Health Insurance Marketplace.

As of January 1, 2016, there are three insurance companies participating on the federal Health Insurance Marketplace (aka “the Exchange”) where qualifying individuals in North Carolina can access federal premium assistance programs. Not all insurance companies offer coverage statewide and plans may not be available in every metallic level.


Making health care more affordable

To help make health insurance more affordable and effective, the federal government offers financial assistance, also called subsidies, to individuals and families who qualify based on their income and household size. These subsidies reduce the monthly cost of a health insurance plan for those who qualify.

To qualify for a subsidy under health care reform, you must:

  • Be between 100% and 400% of the Federal Poverty Level (FPL).
  • Not be eligible for public coverage, such as Medicaid, the Children’s Health
    Insurance Program (CHIP), Medicare or coverage through the armed services.
  • Not have access to insurance through an employer. (An exception can be made
    if the employer’s plan doesn’t provide required minimum benefits [also known
    as minimum essential coverage] or if the plan is considered unaffordable – the
    premium is more than 9.56% of the employee’s income.)

More Help

In addition to premium subsidies there are also cost-sharing reductions (CSRs), another type of subsidy that provides further help for those between 100% and 250% of the Federal Poverty Level. CSRs lower the amount you have to pay for out-of-pocket costs like deductibles, coinsurance and copayments. Think of a CSR as an upgrade in your benefits. Based on your income level, the government will help to cover some of the costs of your medical services. That means you pay less money for those services. Keep in mind, to get these benefits you must choose a Silver plan on the federal insurance marketplace.


The Big Picture

Overall, subsidies and CSRs can help lower your health insurance costs significantly if you qualify based on income. Synergy Benefit Advisors can help you learn if you qualify. Even a family of four with a household income of as much as $97,000 may be eligible for a subsidy. The subsidies are paid directly to your health insurance company – you pay the difference between the full premium and the subsidy on your monthly bill.