The Affordable Care Act (ACA), also known as Obamacare, created a standardized set of health plans individuals can purchase on state marketplaces. These plans are categorized into four tiers: Bronze, Silver, Gold, and Platinum.
The Platinum plan is the top tier among these plans and is best for those who need frequent healthcare and can afford higher premiums. They are designed to provide extensive coverage and tailored care.
This article explores key features and advantages of Platinum plans and who is eligible to enroll.
Overview Of Obamacare Platinum Plans
The Platinum plan is the highest tier of healthcare insurance that one can purchase from the federal insurance marketplace.
These plans are designed to cover around 90% of healthcare costs, meaning that the insurance provider pays the majority of the costs. Consumers will only be responsible for approximately 10% of their healthcare needs, charged through deductibles, copayments, and coinsurance.
Because Platinum plans cover most of one’s healthcare needs, they also come with the highest monthly premiums.
Compared to other tiers, these plans usually have the lowest deductibles, which you must pay out-of-pocket for covered services before your insurance starts to pay.
These plans also have an out-of-pocket maximum. An “out-of-pocket maximum” refers to the limit on the total amount of money you will have to pay for covered medical expenses in a year.
All ACA plans, including the top-tier Platinum ones, cover ten essential health benefits, which include
- Outpatient care
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health services
- Addiction treatment
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive and wellness services
Despite the amount they cover, there may be better choices than Platinum plans. A Silver or Gold plan might offer a better balance for people who anticipate needing few healthcare services.
Who Is Eligible For A Platinum Plan?
Income does not determine your eligibility for Platinum plans. Anyone who meets the general eligibility requirements can opt to purchase a Platinum Plan, provided they can afford the typically higher premiums. Eligibility includes:
- You must be a legal resident of the United States.
- U.S. citizens, U.S. nationals, and specific categories of lawfully present immigrants can apply for Platinum plans.
- People who are not eligible for other qualifying health coverage, such as employer-sponsored insurance or government-sponsored plans like Medicare or Medicaid.
Cost & Coverage Of Platinum Plans
The specific costs and coverage of Platinum plans can vary significantly based on various factors. These include your geographic location, age, tobacco use, and the insurance company offering the plan.
The average cost of a Platinum plan for a 40-year-old is $737 a month, with a deductible of approximately $450. But this is just an average, and your specific quote will be based on your situation.
Benefits Of Platinum Plans
There are several benefits you can expect from Platinum plans. As the top tier among ACA plans, you’ll enjoy the following:
- Highest coverage level (90%): Platinum plans offer the highest level of coverage among Affordable Care Act (ACA) plans, covering up to 90% of your eligible medical expenses
- Lower cost sharing: Compared to other ACA plan tiers, Platinum plans have lower copayments, coinsurance, and deductibles.
- Coverage of essential benefits: Platinum plans are required to cover the ten essential health benefits mandated by the ACA, ensuring comprehensive coverage for your healthcare needs.
- Lowest out-of-pocket maximums: Once you reach your out-of-pocket maximum for the year, the insurance company will cover all eligible medical expenses for the rest of the period.
- Reduced risk of unexpected costs: The lower potential for out-of-pocket expenses minimizes the risk of unforeseen and significant healthcare costs.
- Ideal for high medical usage: If you anticipate needing frequent medical services due to chronic conditions, the comprehensive coverage and lower cost-sharing can make managing your medical expenses more affordable.
How To Enroll In A Platinum Plan
You can enroll for or change your healthcare plan during the open enrollment period from November 1 to December 15.
You may qualify for A Special Enrollment Period if you’ve recently married, had a baby, or lost health insurance because of a job change.
If you feel comfortable navigating insurance plans online, you can access plans on the federal insurance marketplace. Create an account or log into your existing account.
Once logged in, you can complete the application form with your information. This will include details about your income, household size, and more. After you submit your application, you’ll see the health insurance plans you’re eligible for. You can filter to see only Platinum plans if that’s what you’re interested in.
You should filter through the Platinum plans and compare them based on costs, coverage, and network.
Once you find a plan you like, follow the prompts to enroll. Remember, you must pay your first premium to activate your coverage.
Alternatively, you can contact Enhance Health, where our experienced professionals can help you navigate the marketplace and find the best plan for you.
Our insurance representatives understand the insurance industry, including the various plans, coverage options, and regulations. They can help you navigate the complexities of health insurance and provide personalized advice based on your specific needs.
Renewal Policies Of The Platinum Plan
The renewal policies of a Platinum plan are the same as any other plan you might purchase from the marketplace. Each year, your health insurance company will send you a letter outlining any changes to your plan for the upcoming year and a notice detailing what you need to do to stay covered for the following year.
If you want to keep your current plan, updating your income, household, and other information on your application (during the open enrollment period) is important. Doing this can ensure you get the correct savings you’re eligible for.
After updating your application information, you can review all available plans. Even if you’re happy with your Platinum plan, there might be other plans that are now a better fit for your needs and budget. Select the plan you like, or re-enroll in the one you had the previous year and then pay your first premium.
Researching and comparing different health insurance plans can be time-consuming and overwhelming. Our helpful insurance agents at Enhance Health can save you time by presenting you with a curated selection of plans most relevant to your situation.
Key Takeaways
Platinum plans from the ACA offer the best health coverage with the highest premiums and lowest out-of-pocket costs. These plans are best for those who frequently use medical services or want to minimize out-of-pocket costs as much as possible.
When choosing a healthcare plan, make sure to consult Enhance Health. Our team of professionals can answer any question and help you choose the best insurance plan for your budget and needs.
Don’t wait; contact us today to get started!
