The Six Plan Levels of Covered California
The Covered California health insurance marketplace helps connect thousands of Golden State residents with the critical health insurance benefits they deserve. However, because everyone’s health insurance needs and budgets are different, it’s important that you choose the most optimized plan for you.
The Covered California marketplace makes this process easy by separating plans into six different categories of coverage called metallic plan levels. While numerous policies are available under each category, each policy is designed to offer a similar (though not always identical) level of coverage as plans within the same category. However, each category’s level of coverage is different from that of the other categories. As a result, you need to compare the coverage options offered by each category to determine which is best for you and your family.
Understanding Metallic Plan Levels
After the Affordable Care Act (ACA) went into effect, health insurance plans underwent major changes. Health insurers are now required to offer certain benefits on all plans. Plus, most individual and family plans available today have been repackaged to better delineate the cost-sharing requirements within. As a result, they have been separated into different metallic plan levels.
Under each plan level, you will be required to pay different amounts out of pocket for the various care you might need to receive—primary care visits, prescription drugs, lab tests, inpatient hospitalization and so on. When enrolling in your plan, it’s best to choose the plan that offers you the best amount of coverage for a premium you can afford.
A minimum coverage plan requires you to pay 100% of most health care costs until you have met the out-of-pocket maximum set by the plan, which is $8,550 for individuals. Therefore, until you have paid $8,550 worth of health care yourself, you will not receive any cost assistance.
Bronze plans are comprehensively the lowest level of health coverage offered under the metallic plan structure. However, it still pays for roughly 60% of your health care costs, on average, each year. Bronze plans also have the highest deductibles of all plan levels. Still, they are among the most affordable plans on the market and are great for those who only need relatively low levels of care.
The average silver plan is designed to pay roughly 70% of your health care costs. However, silver plans also offer cost-sharing incentives that help qualifying individuals pay lower premiums and out-of-pocket costs for the care received. Enhanced Silver 73, Silver 87 and Silver 94 plans are designed to pay 73%, 87% and 94% of your costs, respectively.
As the second-highest level of coverage, gold plans are designed to cover approximately 80% of your health care costs. They also have neither a medical deductible nor a pharmacy deductible.
Although platinum plans are the most expensive of all metallic health plans, they also offer the highest levels of coverage. This benefit will cover roughly 90% of your personal health care costs. Generally, your out-of-pocket requirement with a platinum plan will be the lowest of all plans, too. However, there are times when the benefits offered by a Silver 94 plan will provide more coverage than Platinum level benefits (provided that you qualify for a Silver 94 plan in the first place).
As you can see, each of these plans has its perks and drawbacks. However, here at Quote Valley Insurance, we believe in helping every California resident get the Covered California plan that is best for them. For help determining the right benefits for you, call us at (855) 547-8683 or request your free quote now.