familybusinessseniormembercontactblogtonik
Health Insurance and Health Reform Blog
 
spacer
blue top
HomeHealth Insurance Blog › Comparing Exchange Plans: Bronze, Silver, Gold, Platinum

Comparing Exchange Plans: Bronze, Silver, Gold, Platinum

October 17, 2014

By Ray Wilson+

The Affordable Care Act, commonly known as ObamaCare, has four new health insurance plans which set the standard of care, named Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan*. All plans must offer the same ObamaCare essential benefits, however individual providers and states may offer extended or additional benefits. This page is dedicated to comparing the four plans.

*There is also ObamaCare catastrophic coverage for those who qualify.

Comparing Exchange Plans Image

Plan Basics

The below information is for families and individuals. Click here for information about ObamaCare Small Business Owners. This information does not include the two types of federal subsidies: premiums and cost-sharing, click here if you want to learn Are You Qualified for Premium Subsidies? or if interested to learn, Are You Qualified for Cost-Sharing Subsidies?

Benefits** Bronze Silver Gold Platinum
Deductible $5,000 Med/Rx $2,000 Med $0 $0
Preventive $0 $0 $0 $0
Doctor’s Office Visits $60 for first 3 $45 $30 $20
Specialist $70 after deductible $65 $50 $40
Generic Rx $15 after deductible $15 $15 $5
Brand RX $50 after deductible $50 after $250 Rx deduct $50 $15
Lab Testing 30% after deductible $45 $30 $20
X-ray 30% after deductible $65 $50 $40
Maternity 30% after deduct 20% after deduct $600 per day HMO***/20% PPO $250 per day HMO***/10%
Out-patient Surgery 30% after deduct 20% after deduct $600 HMO/20% PPO $250 HMO/10% PPO
Hospital Stay 30% after deduct 20% after deduct $600 per day HMO***/20% PPO $250 per day HMO***/10%
ER Visit $300 after deductible $250 after deductible $250 $150
Urgent Care $120 after deductible $90 $60 $40
Out-of-Pocket Max $6,350/$12,700 (ind/fam) $6,350/$12,700 (ind/fam) $6,350/$12,700 (ind/fam) $4,000/$8,000 (ind/fam)
Details Bronze Plan Silver Plan Gold Plan Platinum Plan

***Up to 5 days in the hospital

**Because California has standardized its health plans these are the costs associated with them. Each state will vary. Call 800-930-7956 or click here to get an exchange quote in your state.

Which is the right Healthcare Exchange plan for you?

To select the right health plan, you should ask yourself 5 key questions:

    1) Do you qualify for federal cost-sharing subsidies and/or only federal premium subsidies?
    2) What will your actual monthly premium cost?
    3) What are the finalized coverage details of each plan?
    4) What is the right amount of coverage for your lifestyle and medical history?
    5) What is the plan’s network of doctors and hospitals?

ACA Application

There is now a website where you can get your paper application and access an agents help with subsidies and picking a plan. Here’s what you do:

      1) Go to Healthapplication.com
      2) Fill out the application
      3) Print and then fax, scan and email, or mail your application to the contact information on the app*
      4) An agent will contact you to inform you of your subsidy status and explain the new plans

*Make sure to send your application in as soon as possible to ensure the earliest possible start date.

Call the number above or contact a Medicoverage agent with any questions.

 

Open enrollment for new health coverage begins Nov 15, 2014. Applications must be submitted before Feb 15,2015. Apply for an ACA Plan Here

DAYS LEFT UNTIL OPEN ENROLLMENT BEGINS. Apply Now




Comments for Comparing Exchange Plans: Bronze, Silver, Gold, Platinum

By Chloe Charles on May 17, 2013

This is really helpful. I am wondering if I’m reading it right that with the Silver Plan you don’t have to meet your deductible to see a doctor whenever you want?

MEDICOVERAGE AGENT RESPONSE

Chloe,
Based on the information we have so far the Silver Plan in California will just require a copay of $45 dollars to see a doctor ($65 to a specialist).  As you inferred you will not have to meet your deductible first on this plan.  We don’t details on how the Silver plan will work in other states and this is all subject to change so please refer back to this site or call us when it gets close to Oct. 1, 2013.
-Chris from Medicoverage.com


By carnes on September 18, 2013

These plans are garbage!  That is coming from someone who actually knows insurance.  According to the chart above if you had a heart attack you would max out your plan and it would cost you $4000.  What is the premium associated with the best plan offered?  I’d bet it’s not cheap. 
Who came up with these max out of pocket rates?  Surely not someone in the insurance business.  There should be a $1000 or $2000 total out of pocket program!!!! 

MEDICOVERAGE AGENT RESPONSE
Carnes,
Thank you for your comment. If you are unhappy with the out of pocket maximums listed above,  you can still purchase a traditional insurance plan at http://www.medicoverage.com/quote.php  These should still be for sell until Dec. 31, 2013.

Rates for the new ACA plans (which start Jan 1. 2014) depend on where you live, your age, provider you choose, type of plan (HMO or PPO), level of coverage (Bronze, Silver etc) and if you qualify for a subsidy. Please call us at 800-930-7956 for your specific monthly premium and to see if you qualify for subsidies to help you out.
-Kelly from http://www.medicoverage.com


By marta on September 20, 2013

We’re going to be paying HIGH PREMIUMS FOR SHITTY PLANS.  OPT OUT.  If my coverage decreases from what it is currently and the premiums are higher I’m going to drop coverage altogether.  What a ripoff.


By Mark Wilson on September 20, 2013

Carnes,
$1000 out of pocket maximum?  What country do you live in? There are no affordable plans for sell right now pre-obama care that have a $1000 total out of pocket maximum. You say you know insurance but I think you are confused with deductibles. Most of these companies add co-insurance. I dare you to show me a plan that people can afford that has a $1000 out of pocket maximum.


By sandy on September 22, 2013

Ya Carnes, What are you talking about max out your plan?With a catastrophic illness, your max would be $4000.That is just a drop in the bucket for what the insurance would be paying. I’m sorry but what an idiot. Have you done the calculations. I think for what we would be saving in premiums, the plans look good to me. I was paying $500he . month no preventative,  I think my deductible was 4,500. No Dr. copays until after deductible was met.I wonder if the insurance companies will start to sell supplements for these like the medicare has supplements? Sandy


By Jim on September 29, 2013

“That is coming from someone who actually knows insurance.  According to the chart above if you had a heart attack you would max out your plan and it would cost you $4000.”

Cost sharing is 10%, with zero deductible. So, if your medical bill was $40,000, you would pay $4,000 and the insurance company would pay $36,000.  If it were $100,000, you would pay $4,000 and the insurance company would pay $96,000. Here on earth, that is excellent coverage for an individual policy.


By Phil on October 01, 2013

Will the ACA offer high deductible plans with Health Savings Accounts?  I currently have such a plan with deductible of roughly $4000.  With three surgeries in the past 1.5 years with costs of over $500,000, I have been happy to pay my $4000 deductible each year after which insurance pays everything.  I am hoping I can find something similar since the insurance company notified me that they will not be offering the same plan after my coverage period ends 4/14.

MEDICOVERAGE AGENT RESPONSE
Phil,
Thank you so much for your question. Insurance companies still have the choice to offer HSAs under health care reform.  There are two ways to get an HSA plan for 2014: 
1) Purchase an off-Exchange plan with a high-deductible or
2) Select a new ACA high-deductible HSA exchange plans

Click the links to learn more or call us at 800-930-7956 to learn about which plan will work for you in your state.
-Kelly at Medicoverage.com


By Robin Snowden on October 03, 2013

After all the hunting on the internet…..I still can not find a screen that lets you compare the bronze,silver,gold or platinum plans side by side. please help

MEDICOVERAGE AGENT RESPONSE
Robin,
While the chart above is a good start at letting you see the differences between the 4 plans, it will not help you decide which plan is exactly right for you in your state. Each state, and in most cases each insurance provider, can offer different deductibles and copays for the bronze, silver, gold and platinum plans making comparison very difficult.

States are just now releasing details of each plan and we are posting up information as soon as it is available.  If you have specific questions about benefits in your state, please give us a call at 800-930-7956.
-Kelly from Medicoverage.com


By chuck on October 04, 2013

we make about 25k per year and don’t see the dr. only about once every 3 months for checkup and monthly maintenance meds costing about $50 in copays.  how does this subsidy dollar figure come into play, as I’ve read on the site that you can get up to a certain amount of your subsidy money back from your plan say the Bronze, which is about $8,500 or you can get it back on your fed. taxes when you file, along with our children tax credits.  what affects how much of the subsidy money you get and how would you be able to get the most of your max subsidy money back.  Also what plan would go the best as we are also in Chapter 11 bankruptcy, as I’m disabled with Social Sec. disability each month.

MEDICOVERAGE AGENT RESPONSE
Chuck,
Thank you so much for your question. Because this is a very specific question I suggest you give us a call at 800-930-7956.

But to give you a general idea, premium subsidies (help with your monthly policy cost) are available on all plans, but if you qualify for cost-sharing subsidies (help with deductibles, copays, and coinsurance -basically financial when you seek medical care) you could only enroll in the Silver plan.  And the good news is subsidies are available immediately, you do not need to wait till tax time.

Again, please feel free to call us, so that we can help you out in your unique case.
Chris from Medicoveage.com


By Jeremy on October 13, 2013

So how do I enroll me and my family right now!! Please help me avoid the rush

MEDICOVERAGE AGENT RESPONSE

Jeremy,
We completely understand your concern. There are lots of traditional plans to enroll in now that will offer you coverage before January 1, 2014. You can get a quote and enroll here quote and enroll here

If you are looking one of the new ObamaCare plans, those begin in 2014 and the rush has already started. Most of our clients have really struggled to sign up in the first 10 days of the October. We don’t recommend you sign up for these plans until they have solved the technical issues and offered working links to plan details and doctor networks.  You have until Dec 15 to sign up for coverage to begin on Jan 1. We are authorized to assist people to sign up so please feel free to call us at 800-930-7956.
-Kelly from Medicoverage.com


By Carol on October 20, 2013

My son called into the healthcare.gov phone number after not being to get through for two weeks online.  He was assigned an ID#, but he was never asked questions regarding his income.  He did provide his SS# however.

So how does he proceed now?  Is there a way he can go online now at healthcare.gov to get to the various types of coverage he can purchase and see if he is eligible for any assistance?  He lives in Texas.  Thank you

MEDICOVERAGE AGENT RESPONSE

Carol,
Thank you for your question. Many of clients have experienced the same delays as your son. Tell him he is able to work with an agent. That way he doesn’t have to wait for a long time. But until doctor and hospital networks are available, however, we are suggesting that people wait to enroll. Also, remind him there isn’t a rush, as he is able to enroll until Dec 15th for a January 1st start date. When he’s ready have him give us a call at 800-930-7956.
-Chris from Medicoverage.com


By gringo on October 31, 2013

The chart has nany items followed by a single asterisk. But there is no explanation for the asterisk down below the chart. Pls explain!

MEDICOVERAGE AGENT RESPONSE

Gringo,
Thanks for the feedback! The single asterisk denoted that those prices are only available after the deductible is met. We removed the single asterisk from the chart and included the additional information in the actual field to to make it less confusing. 
-Eric from www.medicoverage.com


By Katherine on November 06, 2013

My husband is a 63 year old retiree of our state government.  So, we may continue with our current insurance for as long as we want, at the full cost of over $1800 a month for the current plan.  (It compares to the “Platinum” plan of the ACA)  Paying for this would take some 40 percent of our income.  Would we be eligible for tax subsidies if we stay with this insurance?  So far, the state I live in, which is part of the “federal exchange,” has no plans offering either of the predominant healthcare provider networks in our area.  I love the idea of the ACA, but the actual logistics are, to put it mildly, incomprehensible,  Thanks!

MEDICOVERAGE AGENT RESPONSE

Katherine,
You should qualify for the subsidies if your household income for a family of 4 is roughly $94,000 or under. Call us at 800-930-7956 and give us the state and actual income and we will be able to tell you if you qualify for subsidies, as well how much your specific subsidy would be.
-Michelle from Medicoverage.com


By Anonymous on November 13, 2013

No subsidies for platinum plans? What kind of shit is that? Continue the fight for HR. 676. 100% coverage for a sliding medicare tax. Come on America, we can do better than this.


By Chuck on November 15, 2013

Hey Anonymous…

There are subsidies for platinum plans. Why do you think subsidies aren’t available? The monthly subsidy would be the same regardless of which plan you get.


By Richard Johnson on November 15, 2013

I am 60 and single and if I purchase the gold plan for 452.00/month($5,424 a year) and go to the doctor 4-5 times a year, total $150.00 and take prescription drugs totaling $235.00 a month ($2,820 a year) Then I can expect to spend $8,390.00 on healthcare right  

MEDICOVERAGE AGENT RESPONSE

Richard,
Thank you for your question.  The cost-share amounts for the Gold Plan vary by state and sometime even by provider.  We are not able to answer your question without knowing which state you are in and which provider is offering the Gold Plan. However, from what you are saying, you may find that a Platinum plan may work better for you, due to the lower cost-sharing, even though it has a higher monthly premium. Call us at 800-930-7956 and we will be able to give your specific plan information for you.
-Michelle from Medicoverage.com


By Mike on November 30, 2013

Hi, I had a kidney transplant when I was 16 years old (7 years ago). I am having trouble deciding which plan to choose. My family makes about $45,000 a year. They do not have insurance through their employers. I am still in college. My main medical cost are: I see a kidney specialist every 4 month and has lab work every month. What plan is best under my circumstances?

MEDICOVERAGE AGENT RESPONSE

Mike,
Thanks for your question. While bronze may be the least expensive plan when comparing premiums,  you may save money by getting a plan with a smaller deductible.  Due to the nature of your specific question we suggest you call 800-930-7956 to speak with an agent to figure out which is the exact best plan for you.
-Eric from Medicoverage.com


By RS on November 30, 2013

How will I be able to find out if my current doctors will participate in any of these plans? Will referrals be required to see specialists?

<STRONG>MEDICOVERAGE AGENT RESPONSE</STRONG?

RS,
Thank you for your question. Referrals are required in certain plans like HMOs, however it is not required of all plans. The insurance providers are just starting to submit their doctor networks. To learn which doctors are participating in a particular plan call us 800-930-7956.
-Eric at Medicoverage.com


By pete wetherell on December 03, 2013

u ask for last years income to base the rate. i lost my job in jan 2013. no income, no ins. the cheapest rates, the hope to pay any deductible, are beyond possibility. those rates don’t include eye and dental care.  my medical condition precludes ambulation. i volunteer to teach. but not eligible for hiring if temporarily unable to walk halls, classrooms.


By carmen logan on December 20, 2013

bronze plan is what i want.



Leave a comment















ObamaCare by State
Find the latest ACA news on your state here




Current Members Click here




Insurance services provided by Medicoverage Inc. DBA Regal Benefits insurance services. Copyright © 2004-