The Platinum Plan is one of four new categories of health insurance plans created by the Patient Protection and Affordable Care Act (also known as Obamacare). A Platinum Plan is designed to offer the lowest out-of-pocket expenses for enrollees. Platinum Plan enrollees pay approximately 10% of the out-of-pocket costs of healthcare services with the plan paying the remainder. In comparison, the Bronze Plan requires enrollees to pay 40% of covered medical expenses.
Since the Platinum Plan has the most generous cost-sharing for enrollees, it is expected that these plans will typically have the highest premiums when compared to the Bronze, Silver, and Gold plans. However, this is a generalization. It will be important to compare premiums among different insurance companies offering Platinum Plans. Moreover, deductibles and copayments will also differ among Platinum Plans. This is perfectly acceptable as long as the Platinum Plan covers 90% of healthcare expenses for a standard population. Below is a hypothetical example revealing how cost-sharing could differ among Platinum Plans.
|Platinum Plan Example A||Platinum Plan Example B|
|Consumer Out-of-Pocket Costs||10% of costs||10% of costs|
Insurance companies are not obligated to offer a Platinum Plan. To participate in an State Insurance Exchange they must only offer a Silver Plan and a Gold Plan.
While Platinum Plans share the same essential benefits as offered in Bronze, Silver, and Gold Plans, an insurer has the option to add extra benefits. Additionally, states may require plans to offer other benefits in order to participate in a state exchange.
No. An insurer is not mandated to offer a Platinum Plan. Insurers offering health plans on exchange must offer at least a Silver Plan and a Gold Plan. Some industry analysts have suggested that insurers may be worried that Platinum Plans will attract more sickly enrollees who have a high rate of utilization for healthcare services. This, however, is speculation.
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