Qualified Health Plans

Metal Tier

Health plans offered in the Marketplace will fall into categories called metal tiers. The metal tiers are bronze, silver, gold, and platinum, and are associated with an actuarial value. Actuarial value is the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, the consumer would be responsible for, on average, 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy. Platinum provides the highest level of coverage, followed by List of Insurance Terms and Definitions for Uniform Translation gold, silver, and bronze.

Metal Tier

Platinum, gold, silver, and bronze are the four metal tiers that make up Qualified Health Plans or Metal Plans. These tiers are simple to compare in terms of premium, deductible, and MOOP (Max out of pocket). Doctor visits, hospital stays, emergency care, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric dental and vision care are all covered by all plans on The Official Health Plan Marketplace.

Preventive care is free, including regular office visits and advised screenings. Some plans may offer extra benefits including coverage for adult dental and vision care.

Qualifies Essential Plan

Customers who sign up for a QHP through the marketplace can be qualified for Advanced Premium Tax Credits (APTCs), which lower the cost of insurance on a monthly basis. According to federal regulations, consumers must now reconcile the amount of tax credit they are qualified to receive based on actual yearly income when they file their federal tax return. APTCs are based on predicted annual income at the time of application. The information required to perform this assignment is available on Form 1095-A.

Households that did not apply for tax credits, were not eligible for tax credits at the time of application, or were eligible but decided not to apply for them would also receive a Form 1095-A. This gives these households one more chance to apply for a premium tax credit. Consumers who signed up for Medicaid, Child Health Plus, a catastrophic plan, or a stand-alone dental plan made available through the marketplace are not obliged to get Form 1095-As, nor will they.

Essential Care offers a comprehensive customer service. Our customers can always receive our help regarding various issues, such as: premium payment, reordering NY Medicaid card or Insurance company member ID card, doctor selection, changing address, explanation of benefits and others.