Woman choosing platinum plan option

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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References

1. “Average Cost of Health Insurance (2021).” ValuePenguin. March 2021. Retrieved from https://www.valuepenguin.com/average-cost-of-health-insurance#metal | 2. “Cost-Sharing for Plans Offered in the Federal Marketplace, 2014-2021.” KFF. January 2021. Retrieved from https://www.kff.org/slideshow/cost-sharing-for-plans-offered-in-the-federal-marketplace/ | 3. “2021 Federal Poverty Guidelines / Federal Poverty Levels .” July 2021. Retrieved from https://www.payingforseniorcare.com/federal-poverty-level

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