What are the plan costs?
Your health insurance costs are affected by:
- Out-of-pocket expenses - deductibles, coinsurance and copays.
There are four types of plans offered to individuals with different combinations of premiums and out-of-pocket expenses:
- Bronze Plans - have the lowest premiums but highest out-of-pocket expenses. Typically the insurance company will pay 60% of covered healthcare expenses while the remaining 40% has to be paid by the individual. By purchasing Supplemental Health Insurance you can eliminate most of the 40% costs.
- Silver Plans - typically cover 70% of covered healthcare expenses with the remaining 30% paid by the individual.
- Gold Plans - these plans are required to cover 80% of covered healthcare expenses with the remaining 20% paid by the individual.
- Platinum Plans - these plans have the highest premiums but the lowest out-of-pocket expenses. The insurer will pay 90% of covered healthcare expenses and the individual will have to pay the remaining 10%.
Out-of-pocket expenses or "cost sharing" does not include your monthly premium. These costs have to be paid by the individual policy holder. The provisions of these costs are not standardized and can vary from insurer to insurer, again emphasizing the need to get expert advice when considering options.
Only when you reach the out-of-pocket limit will you be fully covered for further expenses.
A high deductible plan would leave you most exposed to these out-of-pocket costs should you or your family become ill or require more expensive treatment. Of crucial importance however, is that you cannot be denied coverage with these plans, and cannot be denied coverage for preexisting conditions.
If you are in good health and have generally been healthy, as an alternative, you could decide to get covered with a short term major medical plan. These plans are generally more affordable, however, enrollees will be subject to a tax penalty. Coverage can be denied for preexisting conditions as underwriting is required and the plans are not renewable or guaranteed.