Health Insurance Guide: ACA, Medicare, and Cost-Saving Strategies
By Centers for Medicare & Medicaid Services | 15 min read
Master health insurance with our complete guide to ACA plans, Medicare options, and proven strategies to reduce healthcare costs while maximizing coverage.
Navigating health insurance options can save thousands annually while ensuring proper coverage. This comprehensive guide covers all major insurance programs and strategies to optimize your healthcare spending. ## Understanding Health Insurance Basics **Essential Health Benefits (Required in ACA Plans)** - Ambulatory patient services - Emergency services - Hospitalization - Maternity and newborn care - Mental health and substance abuse services - Prescription drugs - Rehabilitative services - Laboratory services - Preventive care and chronic disease management - Pediatric services **Key Insurance Terms** - Premium: Monthly cost for coverage - Deductible: Amount you pay before insurance kicks in - Copayment: Fixed amount for services - Coinsurance: Percentage you pay after deductible - Out-of-pocket maximum: Yearly limit on your costs ## Affordable Care Act (ACA) Marketplace Plans **Metal Tier Categories** - Bronze: 60% actuarial value, lower premiums, higher deductibles - Silver: 70% actuarial value, moderate premiums and deductibles - Gold: 80% actuarial value, higher premiums, lower deductibles - Platinum: 90% actuarial value, highest premiums, lowest deductibles **Premium Tax Credits** - Available for households earning 100-400% of Federal Poverty Level - Advance payments reduce monthly premiums - Reconciled on tax return annually - Must file tax return to maintain eligibility **Cost-Sharing Reductions** - Available with Silver plans only - For households earning 100-250% of FPL - Reduces deductibles, copayments, and coinsurance - Automatic if you qualify for premium credits ## Medicare Program Overview **Medicare Part A (Hospital Insurance)** - Covers inpatient hospital stays - Skilled nursing facility care - Hospice care - Home health services - Premium-free for most beneficiaries **Medicare Part B (Medical Insurance)** - Covers doctor visits and outpatient services - Medical equipment and supplies - Preventive services - Mental health services - Stand