For introductory information and to understand the mission of this blog, please see the Introduction
Health Insurance Marketplace: Part 5
Platinum, Gold, Silver, or Bronze?
Welcome back! I hope this blog is providing helpful information for people living with cancer. In this post, I want to continue our discussion into the Health Insurance Marketplace (Marketplace), focusing on the differences between Platinum, Gold, Silver and Bronze plan coverage.
If you live in a state that offers health insurance through the Marketplace, check out their link https://www.healthcare.gov/choose-a-plan/comparing-plans/
You can find more information on the Marketplace at www.healthcare.gov or calling 1-800-318-2596. They even have a blog at www.healthcare.gov/blog
If you live in California, Colorado, Connecticut, District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, or Washington, use this link to find your state’s website for health insurance https://www.healthcare.gov/marketplace-in-your-state/#:~:text=People%20in%20most%20states%20use,business%20health%20coverage%2C%20or%20both. Starting November 1, 2020, residents of NJ & PA will no longer purchase health insurance plans from www.healthcare.gov.
Let’s look at the four “metal” levels of Marketplace health insurance plans. There are two excellent links that provide details on this topic:
https://www.healthcare.gov/choose-a-plan/plans-categories/
https://www.healthcare.gov/choose-a-plan/your-total-costs/
When reviewing Marketplace insurance plans, start with Silver plans.
- Silver Plans: Typically Silver plans pay for 70% of your health care bill, and you pay 30%. However if you qualify for a cost sharing reduction, you could receive an “upgrade” and pay as low as 6% of your bill. This is the only “metal” level that offers cost sharing reductions based on your income.
- Check to see if you qualify for a cost-sharing reduction here https://www.healthcare.gov/lower-costs/
- If you qualify, you could save a substantial amount of money
- Most regions offer cost sharing reductions if your income is less than 250% of the Federal Poverty Level (see PDF)
- If you do not qualify for a cost sharing reduction but the out of pocket maximum, deductible, and monthly premium are affordable, this still may be a good option for you.
- Gold Plans: Higher monthly premiums often with lower deductibles and co-pays. Typical plans pay 80% of health care bill and you pay 20%. Compare with Silver plans: monthly premium, deductible, co-pays, and your out of pocket maximum. If you income is above 250% of the Federal Poverty Limit, and your cancer treatment plan will require multiple health care services, this may be a good choice for you.
- Platinum Plans: Not available in all regions. These plans have the highest monthly premium with lowest deductibles. If you plan to use a lot of health care services, and can afford the monthly premium, this may be a good option. Typical plans pay for 90% of health care bill, and you pay 10%. Compare deductibles and out of pocket maximums with other plans. A high monthly premium does not guarantee low out of pocket expenses. If your cancer treatment requires surgery, chemotherapy and radiation, chances are good that your out of pocket expense is going to be high. Compare your maximum out of pocket responsibility for each plan.
- Bronze Plans: Lower monthly premiums but may have high deductibles and co-pays. In most regions, it’s difficult to find a Bronze plan that pays a significant portion of the bill for cancer treatment. Before selecting a bronze plan, ask your health care team for assistance. Call the Marketplace at 1-800-318-2596. There is a wait time, but once you get to a representative, they are extremely helpful in reviewing your options.
A few words of caution:
- Take the time to review each Marketplace health insurance plan that is available to you. It is tempting to select the least expensive, and skip looking into cost sharing options. Poor health insurance plans are worse than no insurance at all. It is also tempting to select the most expensive, assuming the plan pays much more for services than other plans. This is a time-consuming process, but it is an important decision.
- Always look at your out of pocket maximum responsibility (family & individual). This is the annual amount you will need to pay for healthcare services. You may be able to find a plan with lower or same maximum out of pocket responsibility at a lower monthly premium if you chose a different “metal” plan.
- Avoid Marketplace scams. Marketplace representatives do not call you and ask for your bank account, social security number or credit card number. If anyone calls you and asks for this information, do not give it to them.
I hope this information is helpful. If you would like to continue this conversation, please click on the Subscribe button at the top of the Blog page. I would love to hear your comments as well as resources that have worked for you. Please share this information with your family and friends.
Keeping you in my prayers,
Jackie