The essential health benefits package may vary slightly from state to state. Each state creates a benchmark plan, which provides more specific details about coverage including specific benefit limits, state required benefits, and a list of covered prescription drug categories and classes. State benchmark plans can be found on the following webpage: To make it easier for consumers to compare plans on the Marketplace, the plans are categorized using a metal grouping: platinum plans, gold plans, silver plans, and bronze plans. The difference between these categories of plans is the actuarial value, which is the overall healthcare cost that each plan covers. Plans with higher actuarial value (the health plan covers more healthcare costs) have a higher monthly premium. The lower the actuarial value, the lower the premium will be. Levels of Plan Pays On Enrollees Pay On Average* Coverage Average (in addition to monthly premium) Bronze 60 percent 40 percent Silver 70 percent 30 percent Gold 80 percent 20 percent Platinum 90 percent 10 percent *Based on average cost of an individual under the plan and may not be the same for every enrolled person. In looking at the plans, for example, an individual may have more out of pocket costs associated with the provision of health care services with a silver plan than he or she would with a gold plan. But, the individual would have less in premium costs with a silver plan than he or she would with a gold plan. Choosing a health plan is a financial decision based in large part on the individual’s expected health care needs. The monthly premiums will vary not only by metal category, but also by geographic area, age, family size, and tobacco use. Two financial assistance programs help those with low income afford coverage through the Marketplace:
The essential health benefits package may vary slightly from state to state. Each state creates a benchmark plan, which provides more specific details about coverage including specific benefit limits, state required benefits, and a list of covered prescription drug categories and classes. State benchmark plans can be found on the following webpage: To make it easier for consumers to compare plans on the Marketplace, the plans are categorized using a metal grouping: platinum plans, gold plans, silver plans, and bronze plans. The difference between these categories of plans is the actuarial value, which is the overall healthcare cost that each plan covers. Plans with higher actuarial value (the health plan covers more healthcare costs) have a higher monthly premium. The lower the actuarial value, the lower the premium will be. Levels of Coverage Plan Pays On Average Enrollees Pay On Average* (in addition to monthly premium) Bronze 60 percent 40 percent Silver 70 percent 30 percent Gold 80 percent 20 percent Platinum 90 percent 10 percent *Based on average cost of an individual under the plan and may not be the same for every enrolled person. In looking at the plans, for example, an individual may have more out of pocket costs associated with the provision of health care services with a silver plan than he or she would with a gold plan. But, the individual would have less in premium costs with a silver plan than he or she would with a gold plan. Choosing a health plan is a financial decision based in large part on the individual’s expected health care needs. The monthly premiums will vary not only by metal category, but also by geographic area, age, family size, and tobacco use. Two financial assistance programs help those with low income afford coverage through the Marketplace:
2017_WIPA_Manual_Module_4_S.docx