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Get Ohio Health Insurance Coverage After Open Enrollment Deadline Expires

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Ohio Open Enrollment for single and family Obamacare health insurance plans ended on March 31 2014. In 2015, it will end on February 15th. After those dates, you need to purchase a plan through a “Special Enrollment,” that allows you to qualify for available federal subsidies and have any pre-existing condition covered without proving insurability.

What Is A “Special Enrollment” In Ohio?

This refers to specific situations that allow Buckeye consumers to buy policies outside of the normal period. For about 60 days, all Exchange plans that are offered on the Marketplace will be available, regardless of what time of the year this occurs. ACA tax subsidies will apply and there will be no extra fees or charges. To take advantage of these “special” situations, you must have a “qualifying life event.”

Your enrollment eligibility is not impacted by your income (unless you are Medicaid-eligible). Thus, if you have a high income that excludes you from receiving a tax subsidy, it will not affect your right to purchase a policy during this special period. Of course, if you apply during the OE period, you can view specific tips and information here.  And you won’t need a special exemption.

What Are The Qualifying Events?”

No Longer Eligible For Medicaid - If suddenly (for income reasons), you lose Medicaid eligibility, you can enroll. Keep in mind that Medicaid is different than Medicare. Medicare is for persons that have reached age 65 and are no longer working or are not covered under another plan.

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Birth Of A Child Is Considered A “Qualifying Event”

Birth of a child  – This would refer to the newborn, and not the parents of the child. Premiums should be low because of the young age. If the child is born with any type of medical problem, the cost of treatment will be covered. Adoption is also an approved exception, although the appropriate documentation will be needed.

Divorce – This refers to the ex-spouse that is losing their coverage and does not impact the other ex-spouse’s existing plan. You can choose to duplicate (or closely duplicate) benefits, or choose an entirely different plan option.

Cancellation Of Current Plan – Many in-force policies are being terminated with an option to convert to a different policy. Often, the conversion option is extremely expensive and has out-of-pocket costs that don’t match your budget. You may instead, compare Exchange plans that are eligible for the full federal subsidy. Notification of termination usually gives you at least 30-60 days to change policies.

COBRA expires – If you have exhausted your COBRA benefits (usually for 18 months), you no longer have to select a HIPAA plan. Previously, you faced an exorbitant premium that was often higher than COBRA. But starting in 2014, that ended. Now, it is a covered exception and there are many available plans. Most should be less expensive than COBRA.

Marriage -  Regardless of age (must be under age 65), this qualifies. Usually, one spouse loses their coverage, especially if the policy is an employer-sponsored group plan. You may have to change carriers and possibly find  a new doctor, depending on which company you choose.

Termination of employment – One of the most common situations is when a job is lost. At least you won’t have to worry about medical issues since coverage is guaranteed. If the number of hours you are working is reduced, and the result is a loss of benefits, this will also qualify.

Retirement – If you are retiring from your employer and have to select your healthcare options, you are eligible. You may have an option to convert your group plan and that should also be considered. If you are offered a policy by a new employer, you forfeit the right to purchase a policy through SEP.

Move – If you permanently move to a different location which utilizes a different insurer  and creates different policy choices, you may select another plan. Keep in mind that your rate could dramatically fluctuate. For instance, a move from Ohio to New Jersey would not put a smile on your face. Conversely, if you move from New Jersey (or New York) to Ohio, you’ll have more spending money! Most Northeastern states tend to be more expensive than other parts of the US.

Error – If during your last enrollment, an error occurred, it’s possible you may be able to earn an exception. You will be asked to provide documentation and possibly details of the date you spoke to the representative.

“Minimum Essential Health” Benefits Were Lost – These are the 10 basic requirements of all Metal Exchange plans. Other than non-payment, lapse or forgetting to enroll, when any of these benefits are lost from your current plan, this exception may qualify. Maternity is expensive, and if it is removed from your policy, you will probably be able to select another plan. The assumption is that your existing policy was compliant before the removal of benefits.

Reach Age 26 – If you have been covered under a parent’s policy, when you reach 26,  you’re entitled to your own policy. Of course, you do not have to wait until January to apply for the new plan.

Not Eligible For Special Enrollment – Go Short-Term

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Don’t Take A Chance! Get A Cheap Short-Term Plan

If you don’t qualify for any of the exceptions listed above, there is a very low-cost policy available to both individuals and families at any time of the year. Referred to as “short-term” coverage, these temporary contracts will provide the cheapest Ohio health insurance coverage you can purchase. Not all companies underwrite the policies, but there are several trusted carriers that can be used.

The Positives -  The price. As earlier mentioned, it’s cheap and we’ll show some specific examples below. The simplicity. The 12-page applications have been removed, and replaced by a short form with about 3-5 medical questions. If you haven’t been treated by any of the conditions, and you have not been previously denied for coverage, you will automatically (Well…almost) get approved.

If you need coverage quickly, your wait time will be less than 24 hours and an application can be completed in about 10-25 minutes. You can complete the easy form online, or we can email or fax the application. No physical is required and only limited medical information is needed.

Short Term Plan Pricing

And the cost! It’s very inexpensive. The major companies in this niche are Anthem Blue Cross, UnitedHealthcare, Assurant, IHC  Group and HCC Life. Estimated monthly premiums for a 35 year-old male living in the Daytona are area are listed below:

$36 – $5,000 Deductible

$34 – $2,500 Deductible

$40 – $1,000 Deductible

(Lower coinsurance will increase premium)

The Negatives – If you have any existing conditions, it’s likely they will not be covered. And although preventive benefits are  mandated (required by law) to be covered on healthcare plans, the short-term plan is exempt, so you would have to pay for your own annual physicals, OBGYN visits and mammograms.

Also, since it is not Affordable Care Act compliant, you may be subject to a 1% (household income) tax for not purchasing a Marketplace policy. Although we would prefer this tax is waived, in many situations, the money that is saved, far exceeds the 1% penalty (which is scheduled to increase to 2.5% in 2016).

These types of policies are not designed to pay for long-term treatment of chronic illnesses and diseases. In addition to expensive therapy that may be limited, expensive non-generic drug use could create  some challenging financial situations. Other benefits, such as maternity and chiropractor visits are often not covered either.

Regardless of the reasons you missed Ohio Open Enrollment for Obamacare, there are  low-cost options that will allow you to quickly purchase coverage and get covered. We’re here to help.

Broker, Insurance Company Or Government Exchange? – Who Do You Call?

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Purchasing healthcare coverage is  like filing your tax return. You know you have to do it, but it’s time-consuming, frustrating and you hope you don’t have to pay too much. And thankfully, you only have to take care of it once per year.

Here in Ohio, we get a big break. Not only are rates lower than most states, but we have a much broader selection of companies that offer policies. Whether its Anthem BC, Medical Mutual, Kaiser, Aetna, Coventry or UnitedHealthcare, low-cost policies are typically available. And of course, the federal subsidy often saves thousands of dollars per year in premiums.

So…Back to the original question. When you’re shopping for a policy, where do you find the best prices? Since rates are closely scrutinized by the Department Of Insurance,  you can’t get a better “deal” by using a specific, broker, company website or Exchange. However, finding the best low-cost plans that match a customer’s unique needs are best addressed by an experienced broker.

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A Broker Can Help You Select The Best Insurer

Instead of comparing policies from one specific carrier, you’re able to view the best available policies from all major top-rated companies. It’s just like shopping for  a vehicle or appliance. Typically, you would like to see more than one brand before buying. The same applies to buying Ohio health insurance plans. While Anthem may be the perfect fit for your neighbor, perhaps Humana or Kaiser offer better policies for you. Thus, it’s critical to use an independent broker.

Not Just “Any” Broker

Brokers come in all shapes and sizes. Some are young and inexperienced, and others  are terrific resources for information and assistance. Their websites may be constantly updated or simply contain pictures of their favorite pets! You just never know.

With our website, you get the best of everything. We have the luxury of 33 years of experience along with the most modern and updated healthcare software, that helps us research, compare and recommend your best choices. When it’s time to apply or enroll for coverage, we’re at your side (if you want) throughout the entire process. Or just a phone call or email away. The choice is yours. We also provide an updated Q&A page that may easily answer many of your questions and concerns.

Our promise is that you will be presented with the best available options at the lowest possible costs. A federal subsidy, if applicable, will reduce your premium, and only the most reputable companies will be used.

 

Who should I contact

to compare plans, enroll, and seek advice?

 

 

A Licensed Agent

(Broker)

 

 

An Insurance
Company

 

 

The Government Exchange

 

ALL Sources?

Will they show plans ON the government Exchange Marketplace and plans OFF the Exchange (in the Private Market)?

Yes!

Yes, if they are participating in both markets

No, shows only plans on the Government Exchange (Marketplace)

ALL Plans?

Can they show plans from ALL major health Insurance Companies in the state?

Yes!  Independent Agents (Brokers) are licensed and contracted with many insurance companies 

No, only shows their own plans 

No, only the insurers on the Government Exchange (Marketplace) and only those specific plans

 

Personal Advice?

 

 

 

 

   Personal Advisor?

Yes!  Access to the same personal advisor, a licensed and insured Agent (Broker), who has years of experience and specialized training in the new laws

Many advisors in a call center, but no access to the same advisor.  Many of them have years of experience and specialized training in the new laws. 

Many advisors in a call center, or unlicensed and uninsured Navigators and Application Counselors, newly hired and newly trained

   Personal Phone Call?

Yes!

Call Center only

Call Center only

   Personal Consultation?

 

Yes!

No

Unlicensed newly hired Navigators or a meeting at the Exchange Call Center

   Website?

Yes!

Yes

Yes

 

Customer Service after the Sale?

 

 

Customer Assistance and help with understanding the insurance plan, claims, billing, enrollment rights, subsidies, problem resolution?

 

Yes!   

 

Yes, service from an employee of the insurance company

 

Yes, for some but not all issues.  The service is from a government employee.

 

 

Cost

The insurance price is the same no matter which choice you make. 

You do not pay a higher rate by using a broker and/or their website.

Ohio Open Enrollment Help For Obamacare Health Insurance

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If you are enrolling for Ohio healthcare coverage through the Insurance Exchange, You’ll need free professional guidance to help compare the best medical plans, calculate your federal subsidy,  determine eligibility, and enroll online for the best effective date.

Fortunately, we specialize in assisting customers find the most affordable Ohio Marketplace policies, and making it easy to apply and purchase the most comprehensive benefits at the lowest cost. Although we probably say this on every page…it’s important to state it again – there are no costs or fees when we help you enroll.

How We Help You

Selecting the right plan is perhaps the most important part of the process. There are five types of coverage: Platinum, Gold, Silver, Bronze and Catastrophic. Although finding the least expensive offer should always be considered, it’s equally important to select the policy that pays most (or all) of your current medical bills with as little out-of-pocket expenses as possible.

For example, if you are required to have routine blood work every two or three months along with other diagnostic tests, it could be very expensive if you have to meet a deductible to cover these items. Easily, you could pay $2,000 or more. If you take medications, we’ll review the RX benefits of all available plans and show you the policies that will pay the highest percentage of your prescription costs.

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Take Prescriptions? We’ll Help You Find The Best Coverage

However, if an alternative plan places a copay on these types of charges, you might pay $40 instead of $400 when you receive treatment. The premium for this type of Ohio Exchange plan may only be  $5-$15 dollars more per month. We find and discuss these options with you, so you’re getting maximum coverage for your premium.

Also, you will always have “Essential Health Benefits”  included in Marketplace plans, since it is now required. These are 10 coverages that must be included in all non-catastrophic policies. Maternity and mental health are two of the biggest benefits.

Avoiding The Enrollment Nightmare

Although most of the “nightmares” have subsided or are currently being worked on, enrolling for new coverage can still be a challenge for consumers that attempt to secure coverage by themselves. Some of the most common issues are long delays on the phone or online, receiving incorrect subsidy or plan information, not being informed of lower-cost options, and providing financial information to persons that have had no background checks and are newly-hired.

Obviously, we eliminate all of those concerns with a combination of our 33 years of experience, and commitment to simplifying the enrollment process by working and guiding you every step until completion. The bugs and malfunctions of the government healthcare website are challenges we know how to avoid.

Also, as a licensed broker, with many carriers, we offer a direct-enrollment link, so you never have to visit any website other than the broker and insurer links. This typically is available if you do not qualify for any subsidy assistance or you are purchasing an “off-Exchange” policy. These plans are not available through the .gov website or any type of navigator. The application process is also significantly reduced from about 30-40 minutes to 10-20 minutes.

How Long Must I Keep The Policy?

There is no time-period requirement for keeping the plan in-force. So whether you keep it a month, a few months, or a few years, it does not matter. You can cancel at anytime. Billing is usually monthly, so you have time to terminate coverage. For example, if you knew you would qualify for employer-sponsored benefits in four months, of course, you would not want to keep your policy, assuming you liked the group coverages.

Also, even though there is a new Marketplace sign-up every year, you don’t have to apply for new coverage if you like what you have. Conversely, if you previously purchased a plan that no longer fits your needs, we can apply (without answering medical questions) for a new policy.

What If You Miss Open Enrollment In Ohio?

You definitely won’t be the first person! Officially, Open Enrollment ends on March 31st, 2014. However, the next Open Enrollment begins in about nine months, since it is an annual event. Of course, you may not want to go nine months without medical coverage.

If  the deadline is missed, you can apply for a “short-term” plan from several companies through our website. UnitedHealthcare will likely have the lowest rates, and you will be able to keep coverage up to 12 months. Pre-existing conditions would not be covered, since it is not considered an Exchange plan. Premiums are very inexpensive for both an individual and family policy.

Another alternative is purchasing a “limited-benefits” policy. Although it will not contain all of the required 10 essential benefits of an Exchange policy, this type of policy will offer an alternative that provides some financial relief if you incur large doctor and/or hospital bills. Usually, acceptance is just about guaranteed and premiums fluctuate in the $50-$150 per month per person range.

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Don’t Take A Chance By Missing Open Enrollment

What Are The “Special Enrollment Periods?”

You can purchase coverage outside of the designated enrollment periods if you have a “qualifying life event.” You won’t have to answer any medical questions and subsidy eligibility will be offered. Approved by the Department Of Health And Human Services (HHS), some of these “events” include:

Getting married

Adopt or have a child

A change in income that impacts eligibility for cost-sharing or tax credits

Relocation to a different city/state that offers different plan options

Loss of benefits due to divorce, job change, Medicaid, CHIP, COBRA etc…

Loss of coverage because of job termination.

Become a US citizen

If the Government (HHS)  makes an error causing you to lose or change benefits

COBRA Is Expensive. Can I Drop COBRA And Apply For An Exchange Plan?

Yes, COBRA is expensive, since it is designed to mirror your prior employer’s benefits. It often includes low deductibles, which raise the cost of coverage. Often, with the help of your subsidy, the Marketplace prices will be significantly lower, and become a very tempting target for enrollment.

This is the best time to apply for new coverage, since you won’t have to worry about any health-related issues, and you can (with our help), compare and select the policy that gives you the benefits you want at a reasonable cost. COBRA can be easily terminated to coincide with the effective date of your new policy.

However,  if you miss the deadline, and don’t qualify for any special circumstance exceptions (divorce, job termination etc…), you will have to wait for the next Open Enrollment or purchase an ACA non-compliant plan that may have limited coverages.

Ohio Health Insurance Exchange Frequently Asked Questions

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The Ohio Health Insurance Exchange is the new way to buy healthcare in the Buckeye state. Although our website makes it easy for you to compare Marketplace plans and apply for coverage, we understand there are many questions that consumers have. Whether its regarding Open Enrollment, Obamacare subsidies or finding the cheapest options, we have the answers for you.

What Is The Ohio Health Exchange?

It’s the new “Marketplace” that was created by the passage of “The Affordable Care Act.”  Different plans are offered from various companies (not all of them) and policies are quite different since there are mandatory coverages that must be included. Single, family and small business plans are offered.

I Have Coverage At Work Already. Am I Eligible?

More than likely, you can buy a policy since you probably meet all of the eligibility requirements. However, you may not be able to qualify for the federal subsidy. So unless your company coverage is VERY expensive and/or you are in a higher household income bracket, you may be better off with your employer-sponsored plan.

What Is The Tax Penalty If I Don’t Buy Coverage?

Currently it is $95 per year (adults) or 1% of your income, whichever is higher. However, next year it increases to $325 and 2% respectively. And the tax increase again in 2016.

What Companies Can I Buy A Policy From?

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Ohio Health Marketplace Insurers By County

In addition to Anthem (mentioned above), other carriers offering Open Enrollment include Medical Mutual, CareSource, Molina, Kaiser Permanante, HealthSpan and SummaCare. Kaiser has recently been purchased by HealthSpan, so names of approved plans may be changing. Catholic Health Partners, which is headquartered in Cincinnati, is the parent company of HealthSpan. Confusing isn’t it?

What If I Miss Open Enrollment?

“Qualifying Life Events” allow you to purchase a policy outside of the conventional period. Some of the special circumstances include divorce, ending of COBRA, loss of eligibility for Medicaid or CHIP, dependent reaching age 26, moving out-of-state and birth of a child.

You may be able to buy an Ohio health insurance policy that is considered “outside” of the Exchange. However, you will still owe any applicable tax penalties.

Can I Buy A Children’s Only Policy?

Now you can. For the last few years, unless it was a limited short-term plan, other than Assurant, no other carrier wanted the business. But that has changed.

Who Can Buy The Cheap Catastrophic Health Plans?

If you are under age 30, then you are eligible for this low-cost plan. But for anyone else, if no available Marketplace options cost less than 8% of their household income, then they also are eligible to purchase this type of policy.

A catastrophic policy covers all 10 “Essential Health Benefits,” but also features a high $6,350 deductible for individuals and a whopping $13,700 deductible for families. There is no coinsurance so the out-of-pocket expense is $0 after the deductible is met.

What Are The Best Ohio Anthem Blue Cross Plans?

Anthem offers several options in every county. The Gold DirectAccess is perhaps the most comprehensive policy. The Silver and Bronze DirectAccess plans have similar benefits, but with higher out-of-pocket expenses. A children’s dental benefit is also available in conjunction with some of the contracts.

Are Dental Benefits Included?

If you are under age 18, it is a mandatory requirement (One of the 10 Essential Benefits) that you have access to  coverage as part of your healthcare policy or separately.  Adults can purchase separately a wide range of dental options. Monthly rates usually range from about $7-$10 (Bare bones ) to about $20-$32) (comprehensive).

What Are The Different Billing Options?

That’s one change that will help  many customers. Previously, it was acceptable for a company to require you to pay electronically if you selected the monthly method. However, that practice has changed.  Now,  electronic fund transfers, hard-copy checks,  money orders and debit cards must be accepted. These new billing options will apply to both new premiums and ongoing bills.

Is It True That Only Certain Insurers Have The Cleveland Clinic In Their Provider Network?

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Cleveland Clinic Is In Medical Mutual’s Network

If you purchase an Ohio Exchange plan, Medical Mutual’s  provider  network includes the Cleveland Clinic. However, they are the only listed carrier. If you buy a policy that is non-Obamacare, many companies and managed-care contracts are listed, including Aetna, Anthem BCBS, Boeing, CareSource, Cigna, HealthAmerica, Humana,  Kaiser, Kohl’s, Lowe’s,  MultiPlan, SummaCare, and UnitedHealthcare.

Why Is Medical Mutual Cheaper On The Exchange?

It is possible that 2014 Exchange rates for Medical Mutual will be less than expensive than the cost you are paying now. One reason is the federal subsidy that is applied.  Another contributing factor is that the longer you keep an existing plan (that you have previously purchased), the more rate hikes you will have experienced. And if there were pre-existing conditions present at the time of application, you may be paying a higher premium.

If I Decide NOT to Buy A Policy, Am I Breaking The Law?

Yes, although you aren’t going to go to jail or get arrested. The “individual responsibility requirement”  is the portion of the new legislation that requires you to buy qualified benefits. If you don’t, you must pay the higher of $95 per adult ($47.50 per child) or 1% of your income. The federal tax filing threshold ($10,000/ single fling or $20,000/ joint filing). This tax continues to increase each year.

Are Short-Term Policies Still Available In Ohio?

These types of policies are typically used when you only need temporary benefits. The period of benefits is less than 12 months and often only a few months. Sometimes…just one month. Since they don’t comply with the minimum essential health benefits requirement, they can not be purchased through Exchanges.

However, plans can be purchased (UnitedHealthcare  usually has the lowest prices) through our website. They are not guaranteed renewable and pre-existing conditions are usually excluded.

Can I Drop COBRA During Open Enrollment And Enroll In A Different Plan?

You can apply for a different policy, even if you are presently covered under COBRA. However, it’s important to properly compare the differences in benefits, since it’s likely there are existing medical conditions that are being treated. Also, if you initiate the termination of benefits, you will have to wait until Open Enrollment the following year to change plans. The exceptions would be special approved situations, such as birth of a child or termination of a group contract.

What Is The Average Smoking Penalty For Marketplace Policies?

The law allows companies to charge up to 50% extra for nicotine users. However, here in our beloved Buckeye state, typical increases will vary from about 5%-30%, depending on which carrier that is writing the policy. Since it can often change the amount you pay by hundreds (or thousands) of dollars per year, please contact us for a comparison of the cheapest plans.

List Of Medical Conditions Now Covered Under Obamacare

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Have you been previously denied for a pre-existing condition when applying for health insurance? Or, were you charged a higher premium (perhaps substantially higher) because of a current medical ailment or medications you took in the past? If you have, you understand the difficulty of finding and purchasing affordable healthcare in Ohio.

The good news is that the practice of denying coverage, increasing prices or delaying benefits for specific conditions, has ended. Effective with Open Enrollment  (October of 2013) for 2014 issue dates, you won’t have to answer any medical questions, take a physical or pay a higher cost for any medical treatment you ever had.

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Ohio Exchange Open Enrollment Covers Pre-Existing Conditions

No physicals will be required and the only variables effecting the cost of Ohio health insurance coverage will be your zip code, age and smoking status. You also may qualify for a huge federal subsidy to pay your premium. The credit is based on your individual (or family) projected income for 2014. We’ll be happy to review the calculation with you and explain how affordable coverage has become.

List Of Medical Conditions Now Covered By Ohio Health Insurance Plans:

Acromegaly

Adam’s Stroke’s Syndrome

Addison’s Disease

Adrenocortical Hypofunction And Insufficiency

Aids

Amyotrophic Lateral Sclerosos

Angina

Ankylosing Spondylitis

Aortic Stenosis

Arteriosclerosis

Autism

Bipolar Disorder

Buerger’s Disease

Burkitt’s Lymphoma

Cancer

Cardiomyopathy

Cirrhosis

Congestive Heart Disease

Coronary Heart Disease

Crohn’s Disease

Diabetes

Down’s Syndrome

Hepatitis C

Juvenile Rheumatoid Arthritis

Manic Depressive Psychosis

Marfan Syndrome

Marie-Strampell Disease

Mental Retardation

Mitral Srenosis

Multiple Sclerosis

Muscular Distrophy

Myasthenia Gravis

Myocardial Infarction

Pacemaker

Paranoid Personality

Paraplegia

Parkinson’s Disease

Porphyria

Pregnant (Currently)

Psoriatic Arthritis

Quadripelgia

Rheumatoid Arthritis

Schizophrenia

Sjogren’s Syndrome

Stroke

Systemic Lupus Erythematosis

Tetralagoy Of Fallot

Wilson’s Disease

Yes, that is quite an extensive list. It’s important to understand that although these conditions will not cause your application for Ohio health insurance Exchange coverage to be rejected, you may still incur out-of-pocket expenses for the treatment and/or any medications that are prescribed. The amount of your portion of the cost will depend on the type of plan you have.

Platinum plans will have the least out-of-pocket costs (about 10% of estimated expenses) while Bronze plans, although the cheapest option, will have the highest out-of-pocket costs (about 40%). If your medical bills are extensive and you take multiple medications (and at least one is non-generic), a Platinum or Gold option may be your best option.