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One provision of the ACA is to standardize and improve individual health insurance policies. This was done by creating a “metal” ranking for individual/family and small group policies, based on their actuarial value (the percentage of costs that the plan pays across a standard population; for each individual member, however, the percentage of costs that the plan pays will depend on the costs the person actually incurs during the year).
But again, those averages are across an entire standard population of enrollees — for an individual person, the percentage of costs covered by the plan in a given year will depend on how much health care the person needs. A person with significant claims may pay only a tiny fraction of the total costs, whereas a person who only has a few doctor visits in the year may pay all or most of the costs, depending on the plan structure.
The metal designations apply to plans both in and out of the exchanges. Regardless of the metal level, non-grandfathered private plans cannot have out-of-pocket maximums that exceed $9,100 for an individual and $18,200 for a family in 2023.
It’s important to understand that cost-sharing reductions will increase the actuarial value of a Silver plan, in some cases making it better than a Platinum plan. If your income is modest and you’re shopping in the health insurance marketplace/exchange, it’s highly recommended that you carefully consider the available Silver plans. You might find that they provide better coverage than the Gold or even Platinum plans.
At lower incomes a Silver plan is often the right choice, but at higher incomes, Bronze and Gold may make more sense.
Legislation signed today provides substantial premium tax credits and cost-sharing reductions to Americans receiving unemployment benefits.
Sweeping health reform legislation delivered a long list of provisions focused on health insurance affordability, consumer protections.