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Platinum Level Marketplace Plans

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Platinum Level Marketplace Plans

The Patient Protection and Affordable Care Act created four metal level categories of insurance plans for consumers to choose from through state healthcare marketplaces, also called exchanges. Of these, platinum plans will have the highest monthly premium and be the hardest to find.

Platinum plans cover the same ten essential health benefits that all plans on the exchanges must cover:

  • Ambulatory Services
  • Emergency Services
  • Laboratory Services
  • Prescription Drug Coverage
  • Hospitalization
  • Preventive Care
  • Maternity Care
  • Pediatric Services
  • Mental Health Services
  • Rehabilitative Services

Out-Of-Pocket Expenses

Some plans may offer more coverage to make them more appealing. These plans are designed to have the lowest out-of-pocket costs for consumers. On average, platinum plans must cover 90% of healthcare costs, leaving only 10% of costs to be paid by enrollees in out-of-pocket expenses. These figures are based on calculations of how much healthcare will be used by the entire pool of enrollees of a particular plan. For comparison, the out-of-pocket expenses for bronze plan enrollees is around 40%.

Although out-of-pocket expenses, like co-pay, co-insurance and deductibles, are low in these plans, the premiums, which do not count as an out-of-pocket expense, are the highest of any offered on the state exchanges.

Health insurance companies are not required to offer platinum plans in order to join the state exchanges. Coupled with the high cost sharing for insurance companies, these plans may be hard to find. Be sure to check the Summary of Benefits and Coverage carefully before you buy a plan, to make sure it will cover all your needs.

Need Help? Contact RedQuote!

As we administer COBRA for the employers we work with, RedQuote helps beneficiaries compare their COBRA plan with numerous individual plan options to help them choose the best plan for their age, budget and coverage preferences. If your company might be interested in hiring us to offer these options to beneficiaries coming off your group medical plan, contact us today!

Published Dec 28, 2016.

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