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Platinum Plan – Affordable Care Act (Obamacare)

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. A typical platinum plan enrollee pays approximately 10% of the out-of-pocket costs of covered healthcare services with the plan paying the remainder. In comparison, a typical Bronze Plan enrollee pays 40% of covered medical expenses.

Below are the average out-of-pocket cost-sharing expenses for medical services and prescription drugs found across platinum plans.

Cost-Sharing CategoryAverage for a Platinum Plan
Deductible for an individual enrollee$347
Deductible for a family$698
Doctor Visit$16
Specialist visit$30
Generic drugs$7
Preferred brand drugs$31
Non-preferred brand drugs$61
Specialty drugs$126 (copay used for specialty drugs in 54% of plans studied)
Annual cap on out-of-pocket costs for an individual$1,855
Annual cap on out-of-pocket costs for a family$3,710

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 APlatinum Plan Example B
Consumer Out-of-Pocket Costs10% of costs10% of costs
Deductible$250$2,000
Coinsurance10%5%

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.

Platinum Plan Premiums

Platinum plans have the highest premium rates of the four new types of metal plans since they charge the lowest out-of-pocket costs. However, there may be instances where the Platinum Plan for one insurance company may charge a lower premium than the Bronze, Silver, or Gold Plan of another insurance company. HealthPocket’s health insurance comparison tool allows people to compare all the plans available in their area.

Below are the average monthly premiums found for 30, 40, 50, and 60-year-old individuals in Platinum plans across 34 different states.

Age 30Age 40Age 50Age 60
$345$388$543$825

Platinum Plan Benefits

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.

Platinum Plan Enrollment Numbers

According to the Health and Human Services report for marketplace enrollment between October 1, 2013 and February 1, 2014, 7% of persons selecting a marketplace plan chose a Platinum plan. For states running their own marketplaces, 8% of persons selecting a plan chose a Platinum plan. For the federally-facilitated marketplace (FFM), 6% of persons selecting a plan chose a Platinum plan. Specifically in the FFM 6% of both females and males selecting a plan chose a Platinum plan.

In terms of plan selection by age, 10% of persons selecting a plan in the FFM under age 18 chose a Platinum plan. Moreover 5% of persons aged 18-25, 6% of persons aged 26-34, and 7% of persons aged 35-44 selecting an FFM plan chose a Platinum plan. Furthermore 6% of persons

Average Out-of-Pocket Costs for Platinum Plans on the Small Business Market

The Affordable Care Act required deductibles to be capped at $2,000 for individuals and $4,000 for families. However, in February 2013 the Department of Health and Human Services stipulated that in order to maintain the appropriate percentage of enrollee out-of-pocket costs, small group health insurance plans used by businesses and other organizations were permitted to exceed the deductible caps.

HealthPocket found the following average out-of-pocket costs for platinum plans in the small business market. No platinum plans exceeded the deductible caps.

Cost-sharing categoryAverage for a Platinum Plan
Medical deductible for individual enrollee$323
Medical deductible for family$647
Primary care visit$16
Specialist visit$29
Annual cap on out-of-pocket costs for an individual$1,620
Annual cap on out-of-pocket costs for a family$3,240

Platinum Plan Frequently Asked Questions

How are Platinum Plans different than other Obamacare health plans?

The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Platinum Plan pays 90% of covered medical costs for a typical enrollee while the other Obamacare health plans pay a lower percentage of these costs.

How much does a Platinum Plan cost?

The monthly premium for a Platinum Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Platinum Plan premiums in your area.

When Can I Enroll in a Platinum Plan?

The first Open Enrollment period for the new Affordable Care Act health plans began October 1, 2013. The coverage for plans enrolled in during 2013 began January 1, 2014. Open enrollment this year ends March 31, 2014. See our Open Enrollment article for more information.

What Is the Deductible Amount for a Platinum Plan?

A deductible is the amount a consumer pays for covered medical services. HealthPocket found individual Platinum plan medical deductibles were $347 on average in the individual and family market.

Do all health insurance companies offer a Platinum Plan?

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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