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What are Marketplace Plans?

AffordableCareCalifornia.org is your destination for nearly every Marketplace Plan available in California under Obamacare.

While you shop around, it is important to know the general difference between each plan. There are five types of Marketplace Plans, four of which are known as “metal plans” since they are categorized as Bronze, Silver, Gold and Platinum. The fifth -- known as the Catastrophic Plan -- is a low-cost, limited coverage plan for major medical events like serious illnesses or emergencies.

What Each Marketplace Plan Has in Common

What each plan has in common is that they all provide you with coverage for these 10 Essential Health Benefits as required by the Affordable Care Act:

  1. Ambulance services.
  2. Emergency care.
  3. Hospitalization.
  4. Maternity & newborn care.
  5. Mental health services.
  6. Prescription drugs.
  7. Rehabilitative services and devices.
  8. Laboratory services.
  9. Preventive services and chronic disease management.
  10. Pediatric services, including dental and vision.

In addition, you cannot be denied coverage under any Marketplace Plan because of a preexisting medical condition.

Comparing Marketplace Plans and Prices

What makes each plan different is the cost. Based on the information you give us, AffordableCareCalifornia.org will provide you with the best plans and rates that meet your needs. This table will give you an idea of what each plan will cover and how much you may be expected to pay out-of-pocket:

Plan Type Monthly / Annual Rate Can Apply Subsidy / Tax Credit If You Qualify? Insurance Pays Your Out-of-Pocket Costs Best for Californians who:
Bronze: Low Cost Yes 60% 40% Rarely need medical services or prescription medication.
Silver: Medium Cost Yes 70% 30% Sometimes need medical services and prescription medication.
Gold: High Cost Yes 80% 20% Regularly need medical services and prescription medication.
Platinum: Highest Cost Yes 90% 10% Needs medical services and prescription medication very frequently. Best for those who have a chronic or major illness that requires ongoing treatment and prescription medication.
Catastrophic:
available only for those under 30. A hardship income exemption is available to those 30 or older
Very Low Cost Lowest monthly cost plan, already heavily discounted. Less than 60% More than 40% Best for those experiencing income hardship and/or under 30 years old. This plan provides coverage in the event of a catastrophic or medical emergency. It also allows for 3 preventative care medical services per year. You must first pay your deductible before the plan will pay for the preventative services

Subsidies Can Greatly Lower Your Rate

You can lower the cost of your monthly or annual premium if you qualify for a government subsidy, technically known as the “Advance Premium Tax Credit.” Think of subsidies like an additional discount.

How much can a subsidy lower my rate by? Well, the amount depends on several factors, including your income, your age, where you live, the number of people in your household and whether or not you smoke.

Do You Qualify for a Subsidy?

Based on the information you provide us, AffordableCareCalifornia.org will help determine whether or not you are eligible for a subsidy and, if so, what the amount of that subsidy may be.

If your household income falls into one of the ranges in the table below, you should qualify for a subsidy that will lower both your premium and your out-of-pocket costs:

# of People in Household Household Income Range
1 $11,670 to $46,680
2 $15,730 to $62,920
3 $19,790 to $79,160
4 $23,850 to $95,400
5 $27,910 to $111,640
6 $31,970 to $127,880
7 $36,040 to $144,120
8 $40,090 to $160,360

If your income is below these numbers, you should be eligible for Medi-Cal, or California’s Medicaid program. You can apply for Medi-Cal using the following web address: http://www.dhcs.ca.gov/services/medi-cal/Pages/ApplyforMedi-Cal.aspx