Basics of ACA

If you buy your own health insurance, understanding these basic facts about healthcare reform, also known as the Affordable Care Act (ACA), will help as you choose your new CareFirst health insurance plan.

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All plans must cover the same core benefits (also called essential health benefits):

Every plan covers these services:

  • Office visits
  • Prescription drugs
  • Preventive care
  • Hospitalization
  • Emergency services
  • Lab tests, blood work, X-rays
  • Immunizations
  • Maternity and newborn care
  • Mental health care
  • Substance abuse services
  • Pediatric dental and vision services (adult dental and vision coverage are not core benefits and are not covered)

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You might qualify for financial help from the government.

To help make health insurance more affordable, the federal government offers two forms of financial assistance called subsidies. Qualifying income levels change slightly each year.

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You can’t be denied access to healthcare.

Even if you’re sick or have a pre-existing condition, no health insurance company can reject you, charge you more or refuse to pay for essential health benefits.

Metal Levels

The ACA has attempted to make comparing different plans easier by requiring that every plan (except for Catastrophic plans, like our BlueChoice Young Adult Plan) fit into one of four categories called metal levels. Bronze, Silver, Gold and Platinum plans all cover the same core benefits, but each level differs in how much your plan will pay toward your care. Different plans have different monthly premiums and varying out-of-pocket costs, such as copayments, deductibles and coinsurance for covered services.

Cost Sharing

Metal Level What the Health Plan Pays on Average What You Pay on Average
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60% 40%
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70% 30%
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80% 20%
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90% 10%

Catastrophic plans, like our BlueChoice HMO Young Adult plan, are not included in one of the ACA's four metal levels. See Plan Types for more information about Catastrophic plans.

Understanding Plan Levels

A lower-deductible or non-deductible plan (Gold metal level) would help you pay for healthcare costs sooner than a higher deductible plan (Bronze metal level). A Silver metal level plan would have a lower monthly premium than a Gold plan. However, it would require you to pay more out-of-pocket costs each year, such as copayments, deductibles and coinsurance for covered services.

Lower Deductible Plan (example: Gold plan) Higher Deductible Plan (example: Bronze or Silver plan)
  • Higher monthly premium 
  • Starts helping to pay for healthcare costs sooner
  • Lower monthly premium 
  • Higher out-of-pocket costs for longer (until coverage starts to help pay more for healthcare costs)