Marketplace plans

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Health insurance affordability programs

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See our  Summary of Benefits and Coverage (SBC).

The Marketplace (also known as the Exchange) is a website (healthcare.gov) where individuals can compare and purchase health insurance plans. Marketplace plans are great for individuals and families who are eligible for discounts or financial subsidies. These discounts can include:

Tax credits - Tax credits lower the monthly premium you pay for health coverage and are more available than ever due to the 2021 American Rescue Plan act. Depending on your household income level, these credits can pay for a considerable amount of your premium. You can use your tax credit on most Marketplace plans.

Cost sharing reductions

  • Lower the amount you pay on health care services.
  • Cost-sharing reduction plans are available for those who make about $31k or less for a single person.
  • Cost-sharing reduction is only available on silver plans.
  • There are three levels of cost sharing reduction based on income brackets:
    • 100–150 percent of FPL
    • 151–200 percent of FPL
    • 201–250 percent of FPL

 

2022 plan year Federal Poverty Level guidelines

 Percentage of Federal Poverty Level
Size of Household100%250%400%
1 Person$13,590$33,975$54,360
2 People$18,310$45,775$73,240
3 People$23,030$57,575$92,120
4 People$27,750$69,375$111,000
Coverage InformationMay qualify for
cost-sharing reductions
and advanced
premium tax credits		May qualify for
cost-sharing reductions
and advanced
premium tax credits		May qualify for advanced
premium tax credits

 

WellFirst Health offers a variety of options for silver plans that are eligible for cost-sharing reduction plans.

Marketplace calculator – see if you qualify for financial help.


Quality star ratings

Exclusive provider organization plans (EPO) plans

Star rating

Overall star rating

Three gold stars and two white stars, indicating a three-out-of-five-star rating
Overall star rating is based on member experience, medical care and plan administration

Member experience

Three gold stars and two white stars, indicating a three-out-of-five-star rating
Rating is based on member satisfaction surveys about their health care, doctors and ease of getting appointments and services.

Medical care

Three gold stars and two white stars, indicating a three-out-of-five-star rating
Rating is based on providers improving or maintaining the health of their patients with regular screenings, tests, vaccines and condition monitoring.

Plan administration

Four gold stars and one white star indicating a four out of five star rating
Rating is based on how well a plan is run, including customer service, access to needed information and providers ordering appropriate tests and treatment.

Health maintenance (HMO) plans

New plan — not rated

Plan quality ratings and enrollee survey results are calculated by CMS using data provided by health plans in 2022. The ratings are being displayed for health plans for the 2023 plan year. Learn more about these ratings.