New Mexicans who still need help enrolling in health insurance before Jan. 31—especially those enrolling for the first time—need education on choosing the right metal level plan.
Nationwide, more than 2 million Exchange enrollees missed out on cost-sharing reductions (CSR) in 2015, according to an analysis by Avalere. Consumers who are eligible for CSR need help and guidance to choose the required silver level plans when it’s appropriate for their situation. Brokers can assist by helping consumers compare the premiums and out-of-pocket costs they’ll pay when receiving health care services.
Metal level choices for New Mexicans last year:
- 23 percent chose bronze level plans
- 62 percent chose silver level plans
- 15 percent chose gold level plans
- Less than 1 percent chose platinum level plans
- Less than 1 percent chose catastrophic plans
New Mexicans benefited from cost breaks to help pay for health insurance:
Bronze, silver, gold or platinum?
- 73 percent of those who enrolled qualified for premium subsidies
- 46 percent also qualified for health plans with cost-sharing reductions
The choice depends on how clients prefer to pay for health care costs, how they use health care and eligibility for CSR. View our chart comparing different metal level health plans.
For those eligible for CSR:
Cost-sharing reductions provide a significant break on out-of-pocket costs for those who qualify based on income (up to 250 percent federal poverty level). See income levels for financial help.
Cost-sharing reductions are only available with silver level health plans through the Marketplace. When consumers shop for health plans based on premium price only, they might pick bronze level plans with low monthly premiums and higher deductibles.
For Native Americans:
Native Americans may get a break on costs in the form of CSR and/or premium subsidies with any health plan on the Marketplace, depending on income. View more information for Native Americans.
For all others:
Premium subsidies are available with any metal level plan in the Marketplace. Some clients may decide it’s worth it to select a health plan with a low monthly premium, even if they’ll have to pay more for health services when they need it. Others may feel more comfortable with a low deductible and lower annual out-of-pocket limit, even if it means paying a higher monthly premium.
Source: CMS.gov. Enrollment Snapshot. December 31, 2015.