Qualified Health Plans

Qualified health plans are health insurance policies that must meet certain standards established by the Affordable Care Act (ACA). Beginning in 2014 every qualified health plan, or QHP, must offer a group of essential health benefits and limit your out-of-pocket medical costs. QHPs must also be certified, or OK’d, by the state or federal marketplace where you buy it.

QHPs also put limits on cost-sharing expenses like deductibles, copayments, and out-of-pocket maximums. In 2015, the most an individual will have to pay for in-network, covered medical care is $6,600. The limit for families is $13,200.

Expert Advice

Be assured that all plans sold in a government marketplace are qualified health plans. This includes both the federal and state-based marketplaces. You can also buy a QHP from a certified Web broker like GetInsured, which is an approved government partner. (Some -- though not all -- employer-sponsored plans meet the requirements of a QHP.)

There are different levels, or “tiers,” of QHPs, but they all offer the same essential health benefits. All plans sold in the marketplace fall into one of four levels: platinum, gold, silver, and bronze. Known as the metal tiers, each level differs according to how much of your medical expenses are covered after you meet your deductible. But they all include the same core group of benefits.

Whichever tier plan you choose, you can be sure you’re getting the same amount and quality of healthcare.

You must buy a QHP in the marketplace to be eligible for tax credits. If your income falls within a certain range you may be eligible for tax credits to help pay your premiums. And, depending on your income, you might be eligible for some cost-sharing benefits when you buy a silver-tiered plan.

However, tax credits can only be used when you buy your coverage on the marketplace, or through a certified Web broker like GetInsured. You can’t use them if you buy a plan outside the marketplace, even if it is a QHP. (The GetInsured Estimator can help you find out if you’re likely to qualify for discounts.)

What Else You Need to Know

Just because a plan isn’t qualified doesn’t mean it isn’t good. It just means it hasn’t gone through the certification process. For example, many employer plans are considered “grandfathered” (meaning they were created before March 23, 2010, and are not required to meet ACA standards) and have not been certified. Despite this, many still offer a complete list of benefits at an affordable price.