Under the Affordable Care Act there are four differently tiered plans offered for individual health coverage. All of the plans are required to cover all 10 of the essential health benefits, including emergency services, wellness visits, pediatric services, prescription drugs, hospitalizations, ambulatory patient services, maternity and newborn care, and laboratory services, as well as other benefits. The major differences between the plans have to do with the percentage of covered expenses, and the amount of money you have to pay out-of-pocket.
Plans offered for individual health coverage in the tiered system are Bronze, Silver, Gold, and Platinum. Bronze level plans have the lowest premiums, but only cover 60 percent of expenses. Silver level plans have slightly higher premiums and cover 70 percent of expenses. Plans at higher levels may also cover additional items, such as dental and vision, while covering a higher percentage of expenses. It is worth your time to consider each level to determine which one would work best for your needs.
For example, if you are in your 30s, visit your doctor twice a year for wellness visits, and only get sick once a year, then a Bronze or Silver plan could be sufficient. On the other hand, if you visit the doctor monthly, have long term medication conditions, and require prescription drugs to manage high blood pressure, cholesterol, diabetes, and other ailments, then a Gold or Platinum plan might be more cost-effective. All plans are eligible for tax incentives, for those individuals who qualify for these discounts, to help lower your monthly premium costs.