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Will Gold plans sold in the exchanges offer more generous coverage? What exactly will a Gold plan cover that isn’t covered by Bronze or Silver plans?

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  • By
  • healthinsurance.org contributor
  • August 12, 2013

Q. I have read that the “Gold” plans sold in the exchanges will offer “more generous coverage.” What exactly will a Gold plan cover that isn’t covered by Bronze or Silver plans?

A. All plans (whether Bronze, Silver, Gold or Platinum) must cover the same 10 essential benefits while also offering free preventive care. To say that more expensive plans offer “more generous benefits” is misleading; they all provide comprehensive coverage. But plans with the lowest premiums (Bronze and Silver) require you to pay a larger share of the cost of those essential benefits. This means that your co-pays and deductibles will be higher.

For example, a Silver plan requires you to pay 30 percent of the cost of doctors’ visits, prescriptions and hospital care out of pocket – up to a maximum of $6,450 in any given year. With a Bronze plan, you’re expected to pay 40 percent of your bills – up to a maximum of $6,450. After that, your insurer will pick up all of the bills for doctors’ care, drugs, hospital care, surgery, rehab, mental health care – everything classified as “essential” care.

What many people don’t know is that if you earn less than 400 percent of the Federal Poverty Level ($62,040 for an individual, $94,200 for a family of four), your out-of-pocket spending will be capped at a lower level.