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Platinum Healthcare Exchange Plan Details

May 10, 2013

By Ray Wilson+

What Is the Platinum Plan?

The Affordable Care Act, commonly known as ObamaCare, has created four health insurance plans which are named Bronze, Silver, Gold, and Platinum*. All plans must offer the same ObamaCare essential benefits, however individual providers may offer extended/additional benefits. Platinum is the most comprehensive of all theses plans with the highest monthly premium but has the lowest out-of-pocket costs (combination of deductible, copayment, and coinsurance).

*There is also Healthcare Exchange Catastrophic coverage, only available to those under thirty and who are unable afford one of the standardized plans.

Platinum Plan Image

Platinum Plan Basics

The following information below is for individual and family members.  Click here to learn about how the Platinum plan works for Small Business owners under ObamaCare.

• 90/10 split, with you paying 10% for healthcare expenses
• Highest monthly premium. This is without federal subsidies, Do I Qualify for Federal Subsidies?
• No deductible for medical services
• No deductible for prescription drugs

Benefits Platinum Health Plan*
Deductible $0
Preventive $0
Doctor’s Office Visits $20
Specialist $40
Generic Rx $5
Brand RX $15
Lab Testing $20
X-ray $40
Maternity $250 per day HMO**/10% PPO
Out-patient Surgery $250 HMO/10% PPO
Hospital Stay $250 per day HMO**/10% PPO
ER Visit $150
Urgent Care $40
Out-of-Pocket Max $4,000/$8,000 (ind/fam)

**Up to 5 days

*California was the first to release its Healthcare Exchange details and much of the copay information we know so far are based on their figures. CHART UPDATED 9/26/13. For information about specific details of the Platinum health plan in your state call 800-930-7956.

UPDATE 11/27/13: For an easy way to fill out your Affordable Care Act application go to Remember to fill it out and send it in as soon as possible to ensure the earliest enrollment date.

Is there only one Platinum Plan?

Although it is expected that Platinum plans will not have a deductible, there may be multiple Platinum plans offered in the same state. Specific plans will be determined by state leaders and insurance providers.

How does the Platinum Plan Compare to the Other New Plans?

Platinum will cost you the most per month, but will have the least out-of-pocket expenses, therefore you will be able to predict your spending in case of emergency or illness. California currently states that the Platinum plan out of pocket Maximum will be $4000 for individuals and $8000 for families. Something important to note is this plan is likely to attract the highest risk persons, which may in turn raise premiums in the future. Click here to compare Bronze Plan, Silver Plan, Gold Plan, and the Platinum Plan side-by-side.

Health Care Reform and Seniors

Seniors do not have the same options because they will still be enrolled in Medicare. Click here to learn about Medicare and the Health Care Exchange.

For any questions or assistance in applying (enrollment goes from October 1, 2013 to March 31, 2014),  please call 800-930-7956 or contact Medicoverage.

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


Comments for Platinum Healthcare Exchange Plan Details

By Chris Leinenweber on August 15, 2013

Are there any published premiums for the metal plans?


Thanks for writing to us. Some states, such as California, Colorado, and New York, have released their preliminary premiums for the new metal plans. It would depend on which state you reside in. Call us at 800-930-7956 to learn if your state has published their premiums.

By Paget Merriman on October 13, 2013

Has Arizona published the preliminary premiums for the new metal plans, specifically gold and platinum?




Thanks so much for your question. Arizona chose not to set up its own Exchange, therefore it defaulted to the fed’s page. Most of our clients have found the fed’s website a bit frustrating. We suggest you wait to sign up until the technical issues are fixed, and plan details such as doctor networks are available. In the meantime, check out Arizona ObamaCare premium rates -remember these are just general prices and don’t reflect all ages and premiums.

And, don’t worry, 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 at

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