Everyone's needs are different.

Examples help us understand.
Find out what the health care law might mean for you.

Single Parent

One Child Under Age 26

Single Person

No Dependents

Married Couple

Two Children Under Age 26

Married Couple

Empty Nest

Jane
Bond

Jane is a single mother with 1 child under the age of 26. Jane’s daughter has asthma.

illustration: Jane Bond, single parent, one child
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Employment

Jane is employed full-time

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Insurance

Currently Uninsured

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Household Income

$27,000

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Health Needs

Daughter has asthma

Impact of the
Affordable Care Act

Jane needs to have health insurance for herself and her daughter or she’ll likely pay a penalty to the government.

Based on her income and household size, Jane may get government help paying for health insurance.

Under the new law, neither Jane nor her child can be denied coverage or charged more based on their health status or pre-existing conditions.

illustration: affordable care act
Cost

The Affordable Care Act includes two kinds of cost savings to help make health insurance more affordable for working families and people with modest incomes. One kind of savings is a new tax credit that could lower the cost of Jane’s insurance premium right away, on any individual, qualified health plan she chooses in the Health Insurance Marketplace.

Another kind of savings could lower the out-of-pocket costs Jane pays when she gets care. This is called a cost-sharing reduction. It may lower what Jane pays for deductibles, coinsurance and copays if she chooses a Silver plan.

illustration: costs
Coverage

Jane is likely to receive a tax credit from the government to help her pay for health coverage. She can use the tax credit right away to reduce her monthly premium cost on any qualified health plan (QHP) she chooses in the Health Insurance Marketplace.

If Jane is eligible for cost-sharing reductions and wants to take advantage of her out-of-pocket savings, she will need to choose a Silver plan when she shops in the Health Insurance Marketplace.

illustration: four metal level plans. bronze, silver, gold, platinum

When Jane compares plans in the Health Insurance Marketplace, she’ll find most are put into 1 of 4 new “metal levels”: Bronze, Silver, Gold or Platinum. The metal level of the plan Jane chooses affects how much her premium costs each month and how she expects to share the cost of care. For example, with a Bronze plan Jane will likely pay a lower premium, but have higher out-of-pocket costs when she needs care. All metal level plans include a core set of 10 essential health benefits (EHBs).

Metal levels do not reflect the quality or amount of care that plans provide.

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Any plan Jane selects will include a core set of 10 essential health benefits (EHBs). EHBs include doctor visits, emergency care, hospitalization, prescription drugs, laboratory services, maternity and newborn services and more.

There are no annual or lifetime limits on the amount Jane’s health plan will pay for these essential health benefits.

By law, all qualified health plans (QHPs) now provide pediatric dental and pediatric vision coverage.

Jane’s plan will also include certain preventive screenings, free of charge.

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Jane can shop for coverage in the Health Insurance Marketplace.

Jane shops online for coverage with Highmark and finds insurance plans that meet her budget and health needs. She can invite an online chat agent to help her explore options. She can even visit the Health Insurance Marketplace directly from the Highmark website.

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To benefit from cost savings, Jane will need to submit an application to the Marketplace. She can apply online, by mail or by phone.

The Marketplace application takes about 30 minutes to complete. Jane will need her tax return and certain other information. With just one application, the government will let Jane know all the programs and cost savings she’s eligible for.

illustration: Jane Bond, single parent, one child

Good news – the Marketplace found Jane eligible for savings! She can apply her savings towards certain plans from the Highmark family of brands offered in the Marketplace.

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Jane gets help finding a plan that’s right for her when she shops online with Highmark. She can also call us, visit a Highmark Direct store or purchase one of our plans from her local insurance agent. When Jane’s ready to enroll, she’ll find options available for making payments.

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Manny
McMann

Manny is a single man with no dependents. He is healthy and doesn’t have major health needs.

illustration: manny mcmann, single, no dependent
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Employment

Manny is employed part-time

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Insurance

Currently without insurance

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Household Income

$23,000

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Health Needs

None. Manny is healthy

Impact of the
Affordable Care Act

Manny needs to have health insurance. He is past his 26th birthday, so he can no longer be covered by his parents’ plan.

If Manny chooses not to get insurance, he will likely pay a penalty to the government. In 2014 the penalty is 1% of his yearly income or $95 – whichever is higher. The penalty increases every year. In 2016 it is 2.5% of income or $695 per person.

Based on his income and household size, Manny may get government help paying for health insurance.

illustration: affordable care act
Cost

The Affordable Care Act includes two kinds of cost savings to help make health insurance more affordable for people with modest incomes. One kind of savings is a new tax credit that could lower the cost of Manny’s insurance premium right away, on any individual, qualified health plan he chooses in the Health Insurance Marketplace.

Another kind of savings could lower the out-of-pocket costs Manny pays when he gets care. This is called a cost-sharing reduction. It may lower what Manny pays for deductibles, coinsurance and copays if he chooses a Silver plan.

illustration: costs
Coverage

Manny is likely to receive a tax credit from the government to help him pay for health coverage. He can use the tax credit right away to reduce his monthly premium cost on any qualified health plan (QHP) he chooses in the Health Insurance Marketplace.

illustration: four metal level plans. bronze, silver, gold, platinum

When Manny compares plans in the Health Insurance Marketplace, he’ll find most are put into 1 of 4 new “metal levels”: Bronze, Silver, Gold or Platinum. The metal level of the plan Manny chooses affects how much his premium costs each month and how he expects to share the cost of care. All metal level plans include a core set of 10 essential health benefits (EHBs).

Metal levels do not reflect the quality or amount of care that plans provide.

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Because Manny doesn’t expect to use a lot of health services in the coming year, he might choose a Bronze plan. This gives him a low monthly premium but higher out-of-pocket costs when he receives care.

Any metal level plan Manny selects in the Marketplace must offer a core set of 10 essential health benefits (EHBs). EHBs include doctor visits, emergency care, hospitalization, prescription drugs, laboratory services, mental health services and more.

There are no annual or lifetime limits on the amount Manny’s health plan will pay for these essential health benefits.

Manny’s qualified health plan will also include certain preventive screenings, free of charge.

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Manny can shop for coverage in the Health Insurance Marketplace.

Manny shops online for coverage with Highmark and finds insurance plans that meet his budget and health needs. He can invite an online chat agent to help him explore options. He can even visit the Health Insurance Marketplace directly from the Highmark website.

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To benefit from cost savings, Manny will need to submit an application to the Marketplace. He can apply online, by mail or by phone.

The Marketplace application takes about 30 minutes to complete. Manny will need his tax return and certain other information. The government will tell Manny all the programs and price breaks he’s eligible for.

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Good news – the Marketplace found Manny eligible for savings! He can apply his savings towards certain plans from the Highmark family of brands offered in the Marketplace.

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When Manny shops online with Highmark, he’ll find plans that match his needs. He can also call us, visit a Highmark Direct store, or purchase one of our plans from his local insurance agent. When Manny’s ready to enroll, he’ll find options available for making payments.

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The
Wilsons

The Wilsons are a married couple with 2 children under the age of 26. There is a third child on the way.

illustration: the wilsons, married, two children
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Employment

Both parents are employed full-time

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Insurance

Currently without insurance

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Household Income

$50,000

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Health Needs

Third child on the way

Impact of the
Affordable Care Act

The Wilsons need to have health insurance for their family or they’ll likely pay a penalty to the government.

Based on their income and household size, they may get government help paying for health insurance.

Under the new law, Mrs. Wilson can’t be denied coverage or charged more for it because she’s pregnant.

All qualified health plans will cover pregnancy and newborn care, plus dental and vision coverage for children.

illustration: affordable care act
Cost

The Affordable Care Act includes two kinds of cost savings to help make health insurance more affordable for working families and people with modest incomes. One kind of savings is a new tax credit that could lower the cost of the Wilsons’ insurance premium right away, on any individual, qualified health plan they choose in the Health Insurance Marketplace.

Another kind of savings could lower what they pay out-of-pocket when they receive care. This is called a cost-sharing reduction. It may lower what the Wilsons pay for deductibles, coinsurance and copays if they choose a Silver plan.

illustration: costs
Coverage

The Wilsons are likely to receive a tax credit from the government to help pay for health coverage. They can use their tax credit right away to reduce their monthly premium cost on any qualified health plan (QHP) they choose in the Health Insurance Marketplace.

illustration: four metal level plans. bronze, silver, gold, platinum

When the Wilsons compare plans in the Health Insurance Marketplace, they’ll find most are put into 1 of 4 new “metal levels”: Bronze, Silver, Gold or Platinum. The metal level of the plan they choose affects how much their premium costs each month and how they expect to share the cost of care. All metal level plans include a core set of 10 essential health benefits (EHBs).

Metal levels do not reflect the quality or amount of care that plans provide.

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The Wilsons might choose a Silver plan to help them balance a lower monthly premium cost with the amount they pay out-of-pocket when care is provided. Or, since they expect frequent visits to their doctor, they might use their tax credit toward a Gold plan, with lower out-of-pocket costs but slightly higher premiums.

Any plan the Wilsons select in the Marketplace must offer a core set of 10 essential health benefits (EHBs). EHBs include doctor visits, hospitalization, prescription drugs, laboratory services and more.

All qualified health plans (QHPs) will include pediatric vision and pediatric dental coverage. Maternity and newborn care are covered, too.

The Wilsons’ plan will include certain preventive screenings, and services like breastfeeding support and supplies, free of charge.

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The Wilsons can shop for coverage in the Health Insurance Marketplace.

The Wilsons shop online for coverage with Highmark and find insurance plans that meet their budget and health needs. They can invite an online chat agent to help them explore options. They can even visit the Health Insurance Marketplace directly from the Highmark website.

To benefit from cost savings for their plan, the Wilsons will need to submit an application to the Marketplace. They can apply online, by mail or by phone.

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The Marketplace application takes about 30 minutes to complete. The Wilsons will need their tax return and certain other information. With just one application, the government will let them know all the programs and cost savings they’re eligible for.

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Good news – the Marketplace found the Wilsons eligible for savings! They can apply their savings towards certain plans from the Highmark family of brands offered in the Marketplace.

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The Wilsons shop online with Highmark and find plans that match their needs. They can also call us, visit a Highmark Direct store, or purchase one of our plans from their local insurance agent. When the Wilsons are ready to enroll, they’ll find options available for making payments.

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Perry &
Terry
Garcia

The Garcias are a married couple with an empty nest.

illustration: the garcias, married, empty nest
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Employment

Perry is self-employed. Terry works part-time

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Insurance

The Garcias’ private insurance plan ends soon

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Household Income

$48,000

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Health Needs

Perry has Type 2 Diabetes; Terry has high cholesterol

Impact of the
Affordable Care Act

The Garcias have private health insurance. When their current policy ends, they’ll need to continue coverage or they may have to pay a penalty to the government.

Based on their income and household size, the Garcias may get government help paying for health insurance when it’s time to purchase a new plan.

Under the new law, the Garcias can’t be denied coverage or charged more because of their health status or pre-existing conditions.

illustration: affordable care act
Cost

The Affordable Care Act includes two kinds of cost savings to help make health insurance more affordable for working families and people with modest incomes. One kind of savings is a new tax credit that could lower the cost of the Garcias’ insurance premium right away, on any individual, qualified health plan they choose in the Health Insurance Marketplace.

Another kind of savings could lower their out-of-pocket costs when they get care. This is called a cost-sharing reduction. It may lower what the Garcias pay for deductibles, coinsurance and copays if they choose a Silver plan.

illustration: costs
Coverage

The Garcias are likely to receive a tax credit from the government to help pay for health coverage. They can use their tax credit right away to reduce their monthly premium cost on any qualified health plan (QHP) they choose in the Health Insurance Marketplace.

illustration: four metal level plans. bronze, silver, gold, platinum

When the Garcias compare plans in the Health Insurance Marketplace, they’ll find most are put into 1 of 4 new “metal levels”: Bronze, Silver, Gold or Platinum. The metal level of the plan they choose affects how much their premium costs each month and how they expect to share the cost of care. All metal level plans include a core set of 10 essential health benefits (EHBs). Metal levels do not reflect the quality or amount of care that plans provide.

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When it’s time to shop for new coverage, the Garcias might select a Silver plan to help them balance a lower monthly premium cost with the amount they pay out-of-pocket when care is provided. Or, since they expect frequent visits to the doctor, they might use their tax credit toward a Gold plan, with lower out-of-pocket costs but slightly higher premiums.

Any plan the Garcias select in the Marketplace must offer a core set of 10 essential health benefits (EHBs). EHBs include doctor visits, hospitalization, prescription drugs, emergency care, laboratory services, mental health services and more.

The Garcias’ new plan will also include certain preventive screenings, like for diabetes and high blood pressure, free of charge.

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The Garcias can shop for coverage in the Health Insurance Marketplace.

The Garcias shop online for coverage with Highmark and find insurance plans that meet their budget and health needs. They can invite an online chat agent to help them explore options. They can even visit the Health Insurance Marketplace directly from the Highmark Health website.

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To benefit from cost savings, the Garcias will need to submit an application to the Marketplace. They can apply online, by mail or by phone.

The Marketplace application takes about 30 minutes to complete. The Garcias will need their tax return and certain other information. With just one application, the government will let them know any cost savings they’re eligible for.

Ave

Good news – the Marketplace found the Garcias eligible for savings! They can apply their savings towards certain plans from the Highmark family of brands offered on the Marketplace.

Ave

The Garcias shop online with Highmark, and find plans that match their needs. They can also call us, visit a Highmark Direct store, or purchase one of our plans from their local insurance agent. When they’re ready to enroll, they’ll find options available for making payments.

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