Woman choosing platinum plan option

A platinum plan is a level of coverage you can purchase on the individual marketplace. It provides guaranteed coverage for certain services, has the lowest cost-sharing, and qualifies for premium subsidies. Keep reading to learn more about platinum plans, expected costs, and guaranteed coverage.

What Is a Platinum Plan?

A platinum plan, also called an Obamacare Platinum Plan, is one of the four main categories (or metal levels) of health coverage. Each category covers a percentage of an average individual’s medical costs. 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.

Platinum is the top category for coverage because it pays 90 percent of the costs (and you pay 10 percent). The platinum plan is followed by gold plans, which pay 80 percent, silver plans, which pay 70 percent, and bronze plans, which pay 60 percent. Because the platinum plan category covers the highest percentage of medical costs, it also tends to have the highest premiums and the lowest out-of-pocket costs.

How Much Does a Platinum Plan Cost?

  • Premium: In 2017, an Obamacare Platinum Plan cost a 21-year-old $363 per month on average.
  • Deductible: Only around 27 percent of platinum plans have a combined medical and prescription deductible, which averaged around $21 in 2016. The 73 percent of platinum plans with separate medical and prescription deductibles had a $409 average medical deductible in 2016. Many platinum plans have $0 deductibles (88 percent with a combined and 27 percent with a separate medical and prescription deductible).
  • Copay: The average copay for a primary care physician visit with a platinum plan was $18 in 2016. For a specialist, the copay averaged $32.
  • Coinsurance: The average coinsurance for a primary care physician visit with a platinum plan was 23 percent in 2016. For a specialist, the coinsurance averaged 21 percent.
  • Out-of-pocket maximum: The average out-of-pocket maximum (for a combined medical and prescription limit) for a platinum plan was $2,437 in 2016.

Can I Use a Premium Subsidy on a Platinum Plan?

Yes. If you qualify for a premium subsidy (premium tax credit), you can use it on a platinum plan. For an individual, you could make between $12,060 and $48,240 and be eligible for a premium subsidy. For a family of four, a qualifying household income would be between $24,600 and $98,400.

What Does a Platinum Plan Cover?

All Obamacare plans 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.

Should I Purchase a Platinum Plan?

If you would like the security of low out-of-pocket costs and can afford higher monthly premiums, then a platinum plan may be the right choice for you. A licensed health insurance agent can help you make that decision at no cost to you, helping you determine your subsidy eligibility, your coverage needs, and compare plan options that fit within your monthly health insurance budget.

Speak to a licensed agent today by calling (800) 304-3414.

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References

https://www.valuepenguin.com/average-cost-of-health-insurance | https://www.kff.org/health-costs/issue-brief/patient-cost-sharing-in-marketplace-plans-2016/

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