Individual and Family Buying Guide
Deciding which plan you need comes down to personal preference. Choose a plan where you're comfortable with the monthly premium as well as the out-of-pocket costs when you use it. This guide will help you decide which plan is best for you.
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The most expensive monthly premium, but you'll pay the least when you use it. Platinum has low copays at the doctor and pharmacy. There's a maximum out-of-pocket of $1,500 per person per year. Very few insurance companies choose to offer this plan.
Who buys Platinum?
People who use their insurance very often. Consider: Do you take several prescriptions, especially high-cost brand name drugs? Do you have expensive healthcare procedures coming up like surgeries, scans, or tests? Do you see the doctor very often? Do you have a serious health issue like cancer, diabetes or a heart condition? Are you pregnant or want to have a baby in the next year?
If you answered yes to one or more of those questions, then you might want to consider Platinum. If you use your insurance often, you'll probably save money, overall, even though this is the most expensive plan.
Gold includes copays for things like doctor visits and prescriptions. The total out-of-pocket is somewhere between $3,500 and $4,500 on most Gold plans (varies by insurance company). And it's generally about 8-10% less expensive than the Platinum plan.
Who buys Gold?
Gold is ideal for someone who probably isn't going to have very expensive medical care next year, but still wants a lower out-of-pocket plan, just in case something happens. Gold is the conservative buyer, who would prefer to pay more monthly premium to spend less on care.
Silver is purchased most often because of it's balance between reasonable price and average benefits. It includes reasonable copays for doctor visits and prescriptions, but you'll have a higher out-of-pocket for the year - usually around $6,350 per person (varies by insurance company). Silver saves 8-10% in monthly premium compared to most Gold plans.
When using a Subsidy Calculator to see if you qualify for lower costs under ACA, the discounts are calculated based on the second lowest-priced Silver plan in your area. But you can always upgrade or downgrade based on your needs.
Who buys Silver?
Someone who wants to keep their monthly premiums low and doesn't think they'll have very expensive medical care next year. If you feel pretty confident that only you'll use your plan for the basics - things like preventive care, doctor visits, and a few low to mid-cost prescriptions - then Silver might be right for you. Silver is ideal for younger individuals and families who want a low-cost plan without giving up copays.
The lowest monthly premium but the highest out-of-pocket for the year. It's usually priced about 8-12% less than a Silver plan. Most Bronze plans don't include any doctor office or prescriptions copays, so you'll pay for those services and they'll apply to your deductible. (Although, some insurance companies offer a Bronze plan with a few doctor copays included.) The most you'll pay out is $6,350 per person per year.
With most Bronze plans, you could set up a Health Savings Account (HSA) at your bank where you could get tax savings, which could help off-set those higher costs when you use your plan. This option will not be available if your Bronze plans offers a few office visit copays per year.
Who buys Bronze?
Bronze is purchased most often by people ages 40 to 64. That's because younger families tend to use their plan very often and enjoy having copays at the doctor and pharmacy, which you usually don't get with Bronze. Young adults who are very healthy also purchase this plan to keep their monthly premium as low as possible.
It's also good for someone who wants the lowest priced option to avoid the penalty for not having health insurance. Bronze plans will be sold for as little as $1 per month based on family size and household income. It's better to take the lowest cost option than not have any insurance at all.
Bronze is also a good financial strategy for some people who have the financial means to pay the $6,350 in case something happened. If so, and especially if they don't think they'll use plan very often, Bronze might provide a huge overall savings.
Please note: when we're talking about "out-of-pocket costs", that includes everything you pay out with insurance that year, even doctor and prescription copays. The only thing that doesn't count toward your out-of-pocket is your monthly premium.
Price Difference, from Top to Bottom: The price difference between Platinum and Bronze is about 30-40% is most areas. There's about an 8-10% difference in price between each plan.
Benefit Difference, from Top to Bottom: The benefit difference between Platinum and Bronze is a $1,500 out-of-pocket with copays (Platinum) versus a $6,350 out-of-pocket without copays (Bronze) in most areas.
Tax subsidies are calculated based on the second-lowest cost Silver plan in your area. But you can always upgrade or downgrade to suit your needs.
Platinum is ideal for somebody who uses their plan often, especially for hospitalizations, testing, treatment, or prescriptions.
Bronze is ideal for someone who rarely uses their plan or who has the financial resources to pay more out-of-pocket costs when they use their plan.
Gold and Silver offer mid-range benefits and pricing. Most people feel most comfortable going with a mid-range plan. Gold is more for the conversative buyer - who'd rather pay more monthly premium and pay less when using the plan. Silver is great for younger individuals and families who want a low-cost option that still includes copays.
Silver is purchased most often, overall.