Q: I’ve heard that the ACA’s premium subsidies only help a person buy a Silver plan which pays for just 70 percent of average healthcare costs. I would like a Platinum plan – which covers 90 percent – but I also would like a subsidy.
A. You can have both. The size of the subsidy is based on the cost of a silver plan, but you can apply it toward purchasing a Platinum policy—or a Bronze or Gold policy. The subsidy can be applied to any metal level, on-exchange plan, but not to catastrophic plans. [Although premium subsidies can be used with a plan at any metal level, cost-sharing reductions, which are another type of ACA subsidy, are only available if you purchase a silver plan.]
If you buy a plan that’s more expensive than the second-lowest-cost Silver plan (the benchmark plan), you’ll pay more than the percentage of your income deemed “affordable” by the ACA. But for any metal-level plan you select, the total cost of the premium will still be reduced by the same amount of subsidy you’d have received if you had purchased the benchmark plan.
As an example, if the benchmark plan is $300/month and your subsidy amount based on that plan is $200/month, you can apply that $200/month to any Bronze, Silver, Gold, or Platinum plan available in the exchange. If you buy the benchmark plan, you’ll pay $100/month. If you buy a plan that retails for $500/month, you’ll pay $300/month. And if you buy a plan that retails for $225/month, you’ll pay just $25/month.
But depending on where you live, you may be limited to a Gold plan as the most robust option, as Platinum plans are not available in all areas. It’s quite common for various areas of the country to only have Bronze, Silver, and Gold plans.
And there are even some areas where only Silver and Gold plans are available. To offer plans in the exchange, an insurer has to offer at least one Gold plan and one Silver plan, but Bronze and Platinum plans are not required. Bronze plans are still offered in almost all areas, but Platinum plans have become much less common over time.