There are four health insurance metal levels offered to those who qualify for coverage through Get Covered Illinois – Platinum, Gold, Silver, and Bronze. Platinum plans offer the highest level of coverage, meaning that your health insurer will pay a higher share of the cost when you access health care services. Platinum plans also come with a higher premium, so you will pay more per month. Bronze plans generally pay a lower share of the cost to access healthcare services, however, your monthly premium will likely be lower. Silver plans are in the middle. However, if you qualify for cost sharing reductions to lower the cost of healthcare, you must enroll in a Silver plan to use this benefit. Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level.
Some examples of plan types offered on Get Covered Illinois:
- Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency).
- Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
- Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan's network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
- Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.