Silver Healthcare Exchange Plan Overview
What Is the Silver Plan?
The Affordable Care Act, commonly known as ObamaCare, has four new health insurance plans, listed from least expensive monthly premium to the most: Bronze, Silver, Gold, and Platinum*. All “metal” plans will all offer the same Healthcare Exchange essential benefits, regardless of any additional or extended benefits an insurance provider offers. Silver is considered the standard of these plans, offering a low monthly premium with the second highest cost-sharing (combination of deductible, copayment, and coinsurance).
*There is also Healthcare Exchange Catastrophic coverage, for those who qualify.
Silver Plan Basics
The following information below is for individual and family members. Click here to learn about how the Silver plan works for Small Business owners.
- 70/30 split, with you paying 30% for healthcare expenses
- 2nd lowest monthly premiums(Not including any federal subsidies. Do I qualify for healthcare subsidies?)
- $2,000 expected deductible
- Silver is the ONLY plan that offers cost-sharing subsidies
|Benefits||Silver Health Plan*|
|Deductible||$2,250 Med/$250 Rx|
|Doctor’s Office Visits||$45|
|Brand RX (Tier 2)||$50 *after $500 Rx deduct|
|Maternity||20% of negotiated rate after deduct|
|Out-patient Surgery||20% of negotiated rate after deduct|
|Hospital Stay||20% of negotiated rate after deduct|
|ER Visit||$250 *after deduct|
|Out-of-Pocket Max||$6,250/$12,500 (ind/fam)|
*This is California’s breakdown of the Silver. For specific information of your state’s plan click here for a health insurance marketplace quote.
How many Silver Plan Deductibles will be offered?
Depends on the provider and state, as both may interpret the plans separately after meeting the essential benefits. Silver plans will have both different deductibles (the amount you pay before the insurance company pays for health services) and coinsurance (the % you pay after the deductible is satisfied and until you meet the out-of-pocket max).
How Does the Silver Plan Compare to the Other New Plans?
Silver is the standard plan, it must be offered, if any plan is offered by a provider, and, as we said above, Silver is also the only plan that offers cost-sharing reductions for out-of-pocket costs. Silver offers a relatively low monthly premium, with a fairly low deductible, so that a member may manage his/her costs. Click here to compare Bronze Plan, Silver Plan, Gold Plan, and the Platinum Plan side-by-side.
Seniors and the Health Insurance Marketplace
Seniors do not have the same options under the new Health Care Exchange. Click here to learn more about ObamaCare and Seniors.