ACA Selling

Milkman1265

Guru
100+ Post Club
736
I'm not a health guy but generally what is the difference in the metal tiers? Is it the coinsurance %?

Also do you need to get appointed with each carrier individually to sell? Or everything is taken care of on the health exchange website. Or it is like life insurance where you submit carrier appointment paperwork with your first app?
 
Metal tiers are separated by their AV, or actuarial value. Google it if you don't understand, it has NOTHING to do with coinsurance.

I can't get a straight answer on appointment from carriers, exchanges, dfs, etc. If anyone has anything in writing I'd love to see it.

Presume you must be appointed individually. They make it very clear that commissions are paid by the carrier to the SA. If you're not appointed, there is a good chance they're not paying you. Besides, what's the downside?
 
so its safer to just get appointed with all the carriers listed on their website before you start helping people do the health app

btw, im comparing bronze plans and they all look indentical but the price is different so i guess the cost difference is the in network doctors avalability?
 
Last edited:
Plans within the exchange are "standardized", which means they are all the exact same plan design, right down to the RX copays. All carriers must offer these standard plans. If they choose, they may offer non-standard plans that still meet the metal-level AV. These plans may have slightly different cost sharing schedules or different deductibles/oop max.

You're paying for brand, service, and network. Network appears to be the big differentiation, cheaper plans have smaller networks, some ridiculously so.
 
Plans within the exchange are "standardized", which means they are all the exact same plan design, right down to the RX copays. All carriers must offer these standard plans.

I have no idea where you are getting this from and I am surprised no one else on this forum has called you on it. This is completely not true - unless you are possibly talking about one specific state with unusual requirements.
 
I was a little surprised by RayNY's statement, too, especially since he is so incredibly knowledgeable about this law. Perhaps NY required standardized plans, and then allowed deviation. In most states there is no such standardized plan. There are simply 4 categories (or tiers) of plans (besides the "catastrophic"), and the tiers are Bronze, Silver, Gold, and Platinum. They are based on the Actuarial Value of 60%, 70%, 80%, 90%. They can vary widely in benefit designs, with different deductibles, copays, prescription benefits, networks, etc. There are some caps, such as the MOOP which must be no more than $6,350 for individuals and $12,700 for families.
 
Apologies,
You guys are correct, I'm stuck in NY mode.

http://www.healthbenefitexchange.ny.gov/sites/default/files/Attachment B - Standard products_0.pdf

In NY, all carriers on-exchange must offer the "standard" or "benchmark" plans with no variance at all. They are allowed to additionally offer "non-standard" plans that have a different design but still are within 2% of the metal tier AV's. It was my mistake assuming other states were also doing this without specifically checking.

Sorry for the confusion.
 
In simple terms "actuarial value" is a measure of the benefits covered by the health plan for a given population. So if the AV is 75% then the plan is expected to cover 75% of the eligible expenses and the member will pay the 25%.

The actual plan design mix of deductibles, co-insurance, etc. can vary.

Hope this helps.
 

Latest posts

Back
Top