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Which exchange plan is best for me?

  • By
  • contributor
  • October 2, 2015

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 subsidy, it will assume that you are buying a Silver plan. If you choose Platinum or Gold, you will have to make up the difference yourself.

But if you buy a Bronze plan, you’ll still be able to apply the same subsidy to your plan, which can make Bronze plans particularly inexpensive for some enrollees. (The caveat is that Bronze plans also come with the highest out-of-pocket exposure.)

If your income doesn’t exceed 250 percent of the federal poverty level, you’re also eligible for cost-sharing subsidies, but those are only available on Silver plans.  Cost-sharing subsidies improve the benefits of the plan, reducing the deductible and overall out-of-pocket costs that insureds pay if they have a claim.  If your income makes you eligible for a cost-sharing subsidy, you’ll almost certainly get the best value with a Silver plan.

Finally, keep in mind that whichever plan you choose, your total out-of-pocket expenses for essential health benefits will be capped at no more than $6,850 in 2016. (Maximum out-of-pocket limits increase each year along with medical cost inflation).

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, deductibles, and coinsurance. (The family maximum out-of-pocket for 2016 is $13,700, but all plans must have embedded individual out-of-pocket maximums starting in 2016, so no single member of a family would have to pay more than $6,850 in covered medical expenses for the year.)