Comparing Exchange Plans: Bronze, Silver, Gold, Platinum
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.
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?
|Deductible||$6,000 Med/ $500 Rx||$2,250 Med/$250 Rx||$0||$0|
|Doctor’s Office Visits||$70 for first 3||$45||$35||$20|
|Specialist||$90 after deductible||$70||$55||$40|
|Generic Rx||100% per script up to $500 after deductible||$15||$15||$5|
|Brand RX||100% per script up to $500 after deductible||$50 after Rx deduct||$50||$15|
|X-ray||100% negotiated rate||$65||$50||$40|
|Maternity||100% of negotiated rate||20% of negotiated rate, after deductible||$600 per day HMO***/20% PPO||$250 per day HMO***/10%|
|Out-patient Surgery||100% of negotiated rate, after deductible||20% of negotiated rate, after deductible||$600 HMO/20% PPO||$250 HMO/10% PPO|
|Hospital Stay||100% negotiated rate, after deductible||20% of negotiated rate, after deducible||$600 per day HMO***/20% PPO||$250 per day HMO***/10%|
|ER Visit||100% of negotiated rate||$250 after deductible||$250||$150|
|Urgent Care||$120 after deductible||$90||$60||$40|
|Out-of-Pocket Max||$6,500/$13,000 (ind/fam)||$6,250/$12,500 (ind/fam)||$6,200/$12,400 (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:
- 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?
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.