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Which exchange plan is best for me?

  • June 21, 2013

Q: Which health insurance exchange plan – platinum, gold, silver or bronze – is best for me?

A: It depends on what you need. Platinum plans will be the most expensive, gold comes next, and bronze premiums will be lowest. All of these plans will cover all essential benefits, but the priciest will pay a larger share of your expenses.

For example, on average, a platinum plan will reimburse your for 90 percent of the cost of covered health care products and services, while you will pay 10 percent through some combination of deductibles, co-pays and coinsurance.

If you expect that, over the course of the year, you will be visiting several specialists, having a baby, buying prescription drugs, or undergoing some costly tests, a platinum plan might well be worth the higher premium.

If, on the other hand, you rarely go to the doctor and – barring an accident – don’t expect to need much healthcare, a bronze plan, that covers 60 percent of costs might well be fine.

If your income makes you eligible for a tax credit to help cover your premiums, when the government calculates your subisdy, it will assume that you are buying a silver plan. If you choose platnium or gold, you will have to make up the difference yourself.

Finally, keep in mind that whichever plan you choose, your total out-of-pocket expenses will be capped at about $6,500, so even if you choose a bronze plan, and wind up in seven-car pileup, that’s the maximum that you will have to pay in co-pays and deductibles.

Read more FAQs about health reform, health insurance exchanges, and essential benefits.