Under the Affordable Care Act (ACT) Also known as “Obamacare”, the law has tried to make plan options easier for people to understand. We now have 4 categories that are described as metallic.
Bronze, Silver, Gold, and Platinum.
These categories are for individual and group health plans both on and off the exchange.
These descriptions are based on how you and the plan are expected to share in the cost of medical claims. Each plan category, has percentages of what the insurance will pay.
60% Bronze, 70% Silver, 80% Gold and 90% for Platinum.
For all the 4 categories, the plans will offer the same set of essential health benefits. The bench mark for the essential benefits has already been set by the federal government for Indiana. The differences in the % are determined by how much you want to share in medical cost with the insurance company.
When you start thinking about sharing the medical expense, you may want the Platinum plan. On this plan you would only pay 10% of the cost, no exceeding your out of pocket maximum. This plan will have the highest premium because you pay the least out of pocket. Some carriers are not even offering Platinum plans, because they know that high utilization people will elect them.
Example: You need a knee surgery. That surgery is going to exceed any out of pocket on any of the plan.
The platinum option has a $750 out of pocket max and then 100% coverage. Your premium is for that plan is $600. The total cost of the year is $7,200 in premium plus another $750 in out of pocket, for a grand total of $7,950.
Same situation on the Silver plan.
Your premium is $400 a month, and the out of pocket is $6,600. You have $4,800 in premium plus another $6,660 in medical claims, and your total is $11,400.
Question: If you knew you were going to have a large procedure, which would be the best plan?
Answer: The Platinum is going to cost you $3,450 less than the Silver.
This is the best way to determine which metallic plan is going to be the best for you and your family. When you work Nefouse & Associates THIS is the kind of value we bring to the table!