September 27, 2021
2 minute read

Platinum Plan: What You Need to Know About This Top-Tier Plan

A platinum plan is one of four healthcare coverage categories, or “metal levels,” you can purchase through the individual marketplace. Although platinum plan health insurance often has the most expensive monthly premiums out of the four metal levels, these plans provide guaranteed coverage for certain services and have the lowest copays and deductibles. Keep reading to learn more about platinum plans, expected costs, and guaranteed coverage.

What Is a Platinum Health Plan?

A platinum plan, also called an Affordable Care Act (ACA) platinum plan, is one of the four main categories or metal levels of health coverage offered through the individual marketplace. This plan pays 90% of your medical costs, leaving you with the remaining 10%. Because platinum plans cover the highest percentage of medical costs, they typically have the highest premiums and the lowest out-of-pocket costs.

What Are the Other ACA Metal Levels?

Each health insurance plan is given a “metal level” under the Affordable Care Act (ACA). Each category covers a percentage of your medical costs. Within each metal level, the percentage covered takes into consideration the cost of premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. So, the plan category with the highest percentage covers the most medical expenses.

Here’s a look at the coverage percentages for each metal level:

  • Platinum plans: 90% (You pay the remaining 10%)
  • Gold plans: 80% (You pay the remaining 20%)
  • Silver plans: 70% (You pay the remaining 30%)
  • Bronze plans: 60% (You pay the remaining 40%)

How Much Does a Platinum Plan Cost?

In 2021, the average premium for an ACA platinum plan is $709 per month for a 40-year-old person.1 Deductibles for platinum plans with a combined medical and prescription deductible averaged $0.2 Deductibles for plans with separate medical and prescription deductibles averaged $459.2 But, it’s important to note that platinum plan premiums vary by region, age, and tobacco use.

Can I Use a Premium Subsidy on a Platinum Plan?

Yes, if you qualify for a premium subsidy, you can use it to purchase a platinum plan. You qualify for a premium tax credit if your annual household income falls between 100% and 400% of the federal poverty level (FPL). Here’s a look at qualifying income limits for 2021:3

  • For individuals: $12,880-$51,520
  • For a couple: $17,420-$69,680
  • For a family of four: $26,500-$106,000

What Does a Platinum Plan Cover?

Like all ACA plans, a platinum plan must cover the following 10 essential health benefits:

  1. Prescription drugs
  2. Pediatric services
  3. Preventive, wellness, and chronic disease management services
  4. Emergency services
  5. Hospitalization
  6. Mental health and addiction services
  7. Pregnancy, maternity, and newborn care
  8. Ambulatory services
  9. Laboratory services
  10. Rehabilitative and habilitative services and devices

Platinum plans may include additional coverage, but the above benefits are required.

How Do I Purchase a Platinum Plan?

If you are looking for low out-of-pocket costs and can manage higher monthly premiums, a platinum plan may be the right choice for you. HealthMarkets can help you shop and compare individual health insurance plans, all at no charge to you.

Get started now by reviewing your options.

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© 2023 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48006-HM-0921

© 2023 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48006-HM-0921

© 2023 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48006-HM-0921