The Affordable Care Act overhauled health insurance plans. Under the ACA, consumers will have the option to purchase 1 of 4 different benefit plans – also referred to as “metal” plans due to their names: Bronze, Silver, Gold, and Platinum. A good way to think about differentiating between the plan is as the metal level increases in value, the greater the coverage provided. Each plan provides coverage for the 10 essential health benefits.
Bronze Plan: pays for approximately 60% of covered medical care and features the lowest premiums, but requires higher deductibles and out-of-pocket maximums that the consumer is responsible for.
Silver Plan: pays for approximately 70% of covered medical care and features premiums that are generally higher than bronze plans (it is possible for one carrier’s silver plan to be cheaper than another carrier’s bronze plan). The deductibles and out-of-pocket maximums are lower than those of bronze plans.
Gold plan: pays for approximately 80% of covered medical care and features premiums that are generally higher than silver plans, but the deductibles and out-of-pockets maximums are lower than those of silver plans.
Platinum plan: pays for approximately 90% of covered medical care and features the highest premiums of the four plans, but also the lowest deductibles and out-of-pocket maximums. These plans provide the most comprehensive coverage.
Insurance companies are only required to offer, at a minimum, a silver and a gold plan. Carriers are also not required to offer a plan everywhere in the country. Therefore, individuals in some areas may have more limited plan options to choose from than other areas.
The premiums for plans are based on several factors:
1) Your age
2) Where you live
3) The number of people you are enrolling with (e.g. spouse or child)
4) Any use of tobacco products (some areas do not allow tobacco usage to affect premiums)
Individuals under the age of 30 and others with hardship exemptions will have an additional option – a catastrophic health plan. These plans are ideally designed to protect you from worst-case scenarios, but would require you to pay for all of your medical care until you meet your deductible – costs for the essential health benefits may still be paid by the insurance company. Catastrophic plans can only be purchased on the exchange and will cover 3 visits to your primary care physician per year and provide some preventative benefits. Please note, while premiums for these plans may be lower than metal plans, they will not be eligible for subsidies.
If you have any questions about health insurance plans or would like a free quote comparison, please feel free to give us a call at 1-800-571-2980. You can also reach us by e-mail at Info@terminsurancebrokers.com 24 hours a day.