ACA Marketplace plans

What this actually is

Marketplace plans are sold in four metal levels plus a catastrophic tier, and every one of them has to cover the same ten categories of essential health benefits. The differences that matter are the network, the drug list, the deductible and the out-of-pocket maximum. Metal level tells you how the cost is split, not how good the plan is.

The part most people get wrong is the subsidy. The advance premium tax credit is calculated from your estimated household income for the coverage year against the federal poverty level, and it is pegged to the second-lowest-cost silver plan in your rating area. You can apply that credit to any metal level, which is why a bronze plan can land at a very small monthly number while a gold plan with the same credit is more honest about your real cost of care.

We enrol Tennessee and North Georgia households on the federal exchange, then stay on the file for the rest of the year. Income change, new baby, a move across a county line: those all touch the subsidy, and none of them fix themselves.

What we do on this line

• Side-by-side comparison of every on-exchange carrier in your county, not just the two that pay best
• A subsidy estimate before you apply, then the real number once the Marketplace runs your application
• Drug-by-drug formulary check against each plan's tier structure
• Doctor and hospital network check, including whether your primary care office is in-network for that specific plan, not just that carrier
• Silver cost-sharing reduction screening if your income lands under 250% of the federal poverty level
• A written summary of deductible, coinsurance, copays and out-of-pocket maximum in plain numbers