What Is a Platinum Health Plan?

Affordable Care Act

What Is a Platinum Health Plan?

Published on January 30, 2019

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The health plans offered under the Affordable Care Act are categorized into different metal levels based on the cost and level of coverage offered. As most people can guess, the Platinum health plan is the highest level plan. This health plan is the one that results in the insurance company paying the highest share of medical costs. However, this generous coverage is paired with a higher price tag than the one that comes with other plans. Is a Platinum health plan the right one for you? The answer will depend on a number of factors related to your health, your income and others unique to you.

What is the Platinum health plan?

Platinum is the highest of the four metal levels: these are Bronze, Silver, Gold and Platinum health plans. While a Platinum health plan offers the lowest out of pocket costs when medical services are needed, it also comes with a premium that is significantly higher than those associated with other plans.

What does a Platinum health plan offer?

As with every ACA-compliant plan, a Platinum health plan must offer 10 services that are deemed essential coverages. These include:

  • Prescription medication coverage. Most plans have a flat out of pocket fee for prescription drugs that are covered by the health plan.
  • Preventive care, wellness checks, and chronic disease management.
  • Emergency health care and services.
  • Pediatric health care coverage: a Platinum health plan for minors must include dental, vision, and medical coverage.
  • Hospital stays. Even with a Platinum health plan, there will often be out of pocket costs associated with hospitalization.
  • Mental health and addiction care.
  • Pregnancy and maternity coverage. The health plan will also cover newborn care.
  • Ambulatory services. These are procedures that are performed on an outpatient basis, such as some minor surgeries.
  • Lab services. These are tests performed for diagnosing potential health issues.
  • Rehabilitative services and devices. These include assistive devices like crutches, as well as health services such as physical therapy.

In most cases, there is a copay or coinsurance payment before the insurer’s share kicks in. However, certain health services are fully covered without any additional cost to the patient. These include a number of preventive care services. These can include the following:

  • wellness check-ups.
  • immunizations, including the flu shot.
  • diagnostic screenings like blood pressure checks, lung cancer screenings and mammograms.
  • preventive medicine such as aspirin to reduce heart attack risk or statins to lower blood pressure.
  • fall prevention for people who are over the age of 65.

Additionally, your plan may offer other coverage at their option. Look at plan details through a licensed broker like eHealth to learn more and compare plan options.

Does the Platinum health plan come with a subsidy?

If you qualify for a healthcare premium subsidy, you can use it to defray the costs of a Platinum health plan. However, the subsidy amount will cover a smaller portion of your premium cost than if you had a lower tier plan. This is because the subsidies are linked to the average cost of a Silver plan in your market.

How much will a Platinum health plan pay?

As a rule, all of the health plan metal levels add up to a different percentage of the cost of medical care. Healthcare.gov estimates the average percentages as the following:
 

Plan Category  The insurance company pays   Insured pays 
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%

 

Who should have a Platinum health plan?

A Platinum health plan offers the highest percentage of medical costs covered out of all the of the metal levels. Someone who expects to use a great deal of health care services may find that it is more economical to opt for a Platinum health plan. While the initial premium is far higher than other options, the peace of mind of knowing that out of pocket expenses for care are covered can provide significant peace of mind.
The right health plan tier for you is a highly personal decision that is influenced by a number of factors. If you are having trouble making a decision, we can help. eHealth can provide information about a number of health coverage options and help you identify the one that will serve you best.

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