When the Affordable Care Act (ACA) became law, health insurance plans were repackaged, and categorized into 4 metal tiers: Bronze, Silver, Gold and Platinum. Covered California took this a step further and streamlined all the plans they offered on-exchange, so they became a real “apples to apples” comparison.
The silver tier is the most popular, so using it as an example, if you were looking at all the Silver 70 plans on the Covered California marketplace, there would be no plans benefit differences. You would only have to decide which carrier you want, and whether you want an HMO, EPO, PPO or HSP. These acronyms represent the type of network you would have access to and essentially which doctors, and hospitals accept your insurance.
Price: $
Popularity:
Deductible: $6,300 Individual
$12,600 Family
Doctor Visits: 1st 3 Visits $60-$95
Generic Drugs: Full price up to $500 per script after drug Ded
Hospital: Full price up to OOP Max
OOP Max: $9,100 Individual
$18,200 Family
Estimated Avg Medical Costs
Insurance Company pays:
60%
You Pay: 40%
Price: $$ and less
Popularity:
Deductible: $5,400 Individual
$10,800 Family
Doctor Visits: $50 – $90
Generic Drugs: $19
Hospital: 20% after deductible up to OOP Max
OOP Max: $9,100 Individual
$18,200 Family
Estimated Avg Medical Costs
Insurance Company pays:
70%
You Pay: 30%
Price: $$$
Popularity:
Deductible: None
Doctor Visits: $35 – $65
Generic Drugs: $15
Hospital: $350 per day up to 5 days (most HMO’s)
30% (PPO, some HMO’s)
OOP Max: $8,700 Individual
$17,400 Family
Estimated Avg Medical Costs
Insurance Company pays:
80%
You Pay: 20%
Price: $$$$
Popularity:
Deductible: None
Doctor Visits: $15
Hospital: $250 per day up to 5 days (HMO)
10% (PPO)
OOP Max: $4,500 Individual
$9,000 Family
Estimated Avg Medical Costs
Insurance Company pays:
90%
You Pay: 10%
The metal plans categories help identify how much you would pay of estimated average medical costs, compared to how much the insurance company pays. It has nothing to do with the quality of care given.
All plans include the 10 Essential Health Benefits that are required to be covered by law.
Below you will see a summary of the 4 metal tiers along with the minimum coverage plan.
Price: $
Popularity:
Deductible: $6,300 Individual
$12,600 Family
Doctor Visits: 1st 3 Visits $60-$95
Generic Drugs: Full price up to $500 per script after drug Ded
Hospital: Full price up to OOP Max
OOP Max: $9,100 Individual
$18,200 Family
Estimated Avg Medical Costs
Insurance Company pays:
60%
You Pay: 40%
Bronze 60 PlanBest For:
A healthy individual/family that does not have medical conditions, but wants insurance just in case something major happens
Features:
Bronze HDHP (High Deductible Health Plan) 60 Plan:
Best For:
A healthy individual/family that wants to take advantage of tax savings, and plans on putting money into a special bank account called a Health Savings Account. This money can be used for medical expenses and the money roles over from year to year.
This is considered a major medical health plan so it would be good for someone who wants catastrophic coverage. In addition, those that prefer alternative medicine find this an attractive option as many of the services can be paid for with money from an HSA. Check the IRS publication 502 as to what medical services are eligible.
Features:
Price: $$ and less
Popularity:
Deductible: $5,400 Individual
$10,800 Family
Doctor Visits: $50 – $90
Generic Drugs: $19
Hospital: 20% after deductible up to OOP Max
OOP Max: $9,100 Individual
$18,200 Family
Estimated Avg Medical Costs
Insurance Company pays:
70%
You Pay: 30%
Silver 70 PlanBest For:
A healthy individual/family who want an affordable middle of the road Obama Care plan that offers reasonable copays for common services such office visits, lab work, and generic drugs
Features:
