To ensure that all Americans have access to a health insurance plan that suits their needs and budget, Congress developed a tiered system of health plans under the Affordable Care Act (frequently referred to as “Obamacare”), which vary both in price and coverage. The plans are available through the healthcare marketplace that was established as part of the Affordable Care Act.
The plans are labeled bronze, silver, gold and platinum; the lowest value metal (bronze) has the lowest premium, while the highest value metal (platinum) has the highest premium. While bronze plans have the lowest premium, they also cover less, shifting more of the cost-sharing responsibility onto the consumer in the form of deductibles, coinsurance rates and copayments. In addition to the four metal plans, a catastrophic plan is also available to qualified individuals for whom the bronze plan is too expensive.
How Much Do the Plans Cover?
The percentages of health care costs the insurance company pays under each plan are as follows:
- Bronze — 60%
- Silver — 70%
- Gold — 80%
- Platinum — 90%
- Catastrophic (emergency services only)
So, if you have a bronze plan, for example, you can expect to pay roughly 40% of the cost of services, procedures and medications. If you have a platinum plan, you can expect to pay 10% of these costs. Again, because the lower value metal plans cover less, the premium is also lower, and vice versa with the higher metal plans.
Under the new healthcare law, all plans must cover 10 essential health benefits, regardless of the insurance carrier. Familiar types of plans such as HMOs and PPOs will be offered through the program, and the maximum out-of-pocket costs in 2014 for any plan purchased through the marketplace are $6,350 for an individual plan and $12,700 for a family plan.
Depending on region, Californians may have several insurance carriers to choose from when applying for California health insurance through the healthcare marketplace. It is possible that plans may be priced differently between carriers, even for the same metal value plan—this is why it’s so important to seek the assistance of a knowledgeable insurance agent, like those at Benefit Packages, to help you find the most affordable and comprehensive coverage.