Plans through Covered California are very similar to individual health plans you’d purchase privately from a health insurance company, with some differences. Covered California offers plans in a tier-based system, with the following levels of coverage:
- Bronze Plan –– Covers 60% of expenses (lowest premium)
- Silver Plan –– Covers 70% of expenses
- Gold Plan –– Covers 80% of expenses
- Platinum –– Covers 90% of expenses (highest premium)
As shown above, the lower the metal value, the less the plan covers, but the lower the premium. Conversely, the higher the metal value, the more the plan covers and the higher the premium. The percentage a person is required to pay for healthcare expenses is referred to as coinsurance. With a silver plan, for example, the insurance company picks up 70 percent of the cost of a covered service or procedure, while the individual pays the remaining 30 percent (the coinsurance amount). Covered California offers traditional plans with which many people are familiar, including PPO and HMO plans.
Cost-Sharing Subsidies and Tax Breaks
Tax breaks and cost-sharing subsidies to help cover the cost of premium and healthcare expenses are helping tens of thousands of people afford health insurance through Covered California. Whether a person qualifies for this assistance is based on income, not employment status.
Individuals with an income of $45,960 or less, or a family of four with an income of $94,200 or less, may qualify. Individuals with incomes of between $11,670 and $28,725, or a family of four with a total household income of between $23,850 and $58,875, may qualify for both reduced premium and reduced out-of-pocket costs for covered services or procedures.
The knowledgeable agents at Benefit Packages are exchange-certified to help consumers purchase coverage through Covered California. Call us today to learn whether you qualify for reduced premium or cost-sharing subsides on a plan through the health insurance exchange.