The Affordable Care Act (ACA), also known as Obamacare, operates health exchanges nationwide designed to make health care coverage accessible to all Americans. All marketplace exchange plans are mandated by law to cover these essential services:
- Emergency services
- Outpatient/ambulatory services
- Preventive/wellness services
- Maternity and newborn care
- Pediatric services
- Therapy services
- Prescription drugs
- Laboratory services
- Mental health and substance abuse services
- Major Obamacare insurance companies include Cigna, Centene, Anthem, and Molina.
- None of these four companies operate marketplace plans in all 50 states, so your options will depend on where you live.
- Companies offer tiered marketplace plans, and in general, higher-tier plans come with more expensive premiums while reducing your out-of-pocket expenses.
If you have to see a specialist, plans will pay some or all costs depending on your plan, but you must have a referral from your primary care physician. You may be eligible to have a subsidy pay part of your marketplace plan premium depending on your household size and income.
Here are some of the top Obamacare insurance companies along with a breakdown of coverage facts.
Cigna participates in the Obamacare exchange in 10 states: Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee, Utah, and Virginia. Cigna offers four plans through the health insurance marketplace:
- Bronze: The bronze plan pays 60% and you pay 40%. This is the least expensive plan.
- Silver: The silver plan pays 70% and you pay 30%. This is a medium-priced plan.
- Gold: The gold plan pays 80% and you pay 20%. This is a high-priced plan.
- Platinum: The platinum plan pays 90% and you pay 10%. This is the highest-priced plan.
Co-pays and deductibles will vary based on your plan, state of residence, and the medical services provided. The Cigna summary of benefits and coverage for 2021 details specific benefits, co-pays, and deductibles for each plan in each state in the Cigna health care exchange.
2. Centene (Ambetter)
Centene is a publicly traded insurer and expanded its participation in the Obamacare health care exchange in 2018. Ambetter is Centene’s health insurance marketplace (HIM) product and operates in these states: Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Michigan, Mississippi, Missouri, New Hampshire, New Mexico, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Washington.
Ambetter offers a variety of plans under three different tiers:
- Ambetter Essential Care (Bronze): This plan offers lower monthly premiums with higher out-of-pocket costs.
- Ambetter Balanced Care (Silver): The balanced care plan is ideal for those who may be eligible for government assistance through subsidy payments. It balances premium payments of out-of-pocket expenses.
- Ambetter Secure Care (Gold): The gold plan has the highest monthly premium but has the lowest out-of-pocket expenses.
All essential health benefits are covered by each plan. Some plans also cover vision and dental care. Specific information about premiums, deductibles, and co-payments along with the details of each plan available in each state can be found by selecting your state on the Ambetter website.
Anthem participates in Obamacare exchanges in 12 states: Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, and Wisconsin. However, coverage is only partial in Missouri (excludes 30 counties in the Kansas City area) and Virginia (excludes the Northern Virginia suburbs of Washington, D.C.).
Anthem health care exchange plan are offered in these four categories:
- Bronze: The plan pays 60% and you pay 40%.
- Silver: The plan pays 70% and you pay 30%.
- Gold: The plan pays 80% and you pay 20%.
- Platinum: The plan pays 90% and you pay 10%.
Plan options, deductible, and co-pay amounts will vary by plan category and state. You can shop for individual and family plans on the Anthem website by entering your ZIP code.
4. Molina Healthcare
Molina Healthcare operates in the health care marketplace in 11 states: California, Florida, Michigan, Mississippi, New Mexico, Ohio, South Carolina, Texas, Utah, Washington, and Wisconsin. Molina offers the following types of plans through the health care exchange:
- Molina Bronze Plans: Lower cost plans, free preventive care, and higher out-of-pocket costs
- Molina Silver Plans: Affordable plans with the lowest costs for doctor visits and urgent care.
- Molina Gold Plans: Plans with lower costs for things like doctor visits and out-of-pocket costs; generally higher premiums.
Specific plan deductibles and co-pays vary by plan and state. For specific plan information, you can view all Molina health insurance exchange plans.