Comparing and Understanding Plans

Last updated: March 30, 2016

Common Questions About Plans

What Insurance Companies Offer Coverage Through the Health Insurance Marketplace? How Can I Get a List of Companies and Plans Available?

Health plans available are listed through the Health Insurance Marketplace at Healthcare.gov and the SHOP Marketplace for Small Business at

healthcare.gov/small-business.

If you don’t have Internet access, you can call the customer service line for the Health Insurance Marketplace at 800-318-2596 and for the SHOP Marketplace for Small Businesses at 800-706-7893,or get help from an agent or other type of assistor.

How Can I Find Out the Details About What a Particular Plan Covers?

All individual and small group plans offered after January 1, 2014 cover all essential health benefits.

To Learn if a Specific Benefit Is Covered, and at What Level, Check a Plan’s Summary of Benefits and Coverage (SBC).

  • An SBC is a uniform document that includes details about what a plan does and doesn’t cover.

  • It also includes information about what kinds of costs you can expect to pay out-of-pocket. For example: copayments, coinsurance, and deductibles.

  • Plans offered through the exchange and in the market outside the exchange come with a SBC.

  • A SBC gives information in the same way for every plan. This makes it easier to compare plans.

The SBC forms are available through the Health Insurance Marketplace or from an agent for plans offered in the market outside the exchange. The Health Insurance Marketplace website at HealthCare.gov includes information about what each plan covers and links to the insurer’s plan brochures.

You can read more about the Summary of Benefits and Coverage here.

How Can I Compare Benefits and Understand What a Plan Covers?

Every insurance company and group health plan must give you a Summary of Benefits and Coverage (SBC). They must also give you a glossary of commonly-used terms. They must do this both before you enroll and each year at plan renewal time.

  • Through an SBC, you can compare insurance options based on covered benefits, excluded services, deductibles, and out-of-pocket costs, as well as other features that may be important to you.

  • An SBC is designed to help you compare plans and understand the benefits and coverage limits of your plan in clear and concise language.

In addition to getting an SBC, the Health Insurance Marketplace allows you to get information about the health plan options available online through the Marketplace’s toll-free telephone number, 800-318-2596, or from agents, navigators or certified application counselors.

A copy of the form for an SBC can be found at http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/sample-completed-sbc.doc

How Can I See and Compare Prices for Plans?

The Health Insurance Marketplace is set up to let you compare policies on the basis of price, actuarial value, and other factors. You can get this information from the Health Insurance Marketplace website at HealthCare.gov or call center 800-318-2596.

Agents, navigators, and certified application counselors should be able to help you compare rates.

You will not be able to see the cost of a specific service or benefit unless that service or benefit is provided through a stand-alone dental plan.

Can an Insurance Company Charge Tobacco Users More Than Non-Tobacco Users?

Yes.

Under the ACA, health insurance companies can ask about tobacco use before they enroll a consumer in a plan. They can then charge consumers who use tobacco products higher premium. This additional premium is not eligible for premium tax credits. Consumers in group plans may not have to pay this extra charge if they complete a tobacco cessation program.

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