Qualified Health Plan - Health Insurance

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What is a Qualified Health Plan in Health Insurance?

<lingo>The Affordable Care Act designates Qualified Health Plans as those that meet certain standards. To qualify, a health plan must be certified by the Health Insurance Marketplace, follow specific cost-sharing limits, and provide a level of health coverage know as ​"minimum essential coverage." Qualified Health Plans are sold in state-or federal-run insurance marketplaces or exchanges. In most cases, those who are already covered by Medicare do not need to purchase a Qualified Health Plan.</lingo>

Qualified Health Plan Explained

Qualified Health Plans must meet a certain number of standards, as designated by the Affordable Care Act. To be certified by the Health Insurance Marketplace as a Qualified Health Plan, plans must provide a certain level of coverage. These essential benefits include: preventative care, mental health  and substance abuse services, hospitalization, pediatric services, ambulatory care, emergency treatment services, laboratory services, rehabilitative services and devices, and prescription medications. 


<twitter>The Affordable Care Act designates Qualified Health Plans as those that meet certain standards.</twitter>



Qualified Health Plans must also fall within specific cost-sharing guidelines set by the federal government. These limits include costs such as deductibles, and co-pays, and set maximum limits on out-of-pocket expenses.  Qualified plans are categorized into four tiers based on the percentage of costs covered: Bronze, Silver, Gold and Platinum. To qualify as Bronze, plans must cover at least 60 percent of expected costs for an average individual. Silver plans must cover 70 percent, Gold plans must cover 80 percent, and Platinum plans must cover 90 percent of expected costs.


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