Silver Plan – Affordable Care Act (Obamacare)
- What is the silver plan?
- What are the silver plan's out-of-pocket costs?
- Tax credit for individuals & families
- Silver plan premiums
- Silver plan enrollment numbers
- Average out-of-pocket costs for silver plans on the small business market
- Frequently asked questions
What Is the Silver Plan?
The Affordable Care Act, sometimes called the ACA, defines four new types of health insurance plans for individuals and families. The four types of plans, ranked from most expensive out-of-pocket costs for consumers to the least, are: Bronze, Silver, Gold, and Platinum. All of these plans will offer the same minimum of benefits. These minimum benefits are determined by the federal and state government and must be included in a plan regardless of any additional benefits the plan decides to include.
For an insurance company to participate in an exchange, i.e. a state-run marketplace offering Affordable Care Act plans, the company does not have to offer all four plans but it must offer at least the Silver Plan and also the Gold Plan.
The Silver Plan has lower out-of-pocket costs than the Bronze Plan but higher out- of-pocket costs than both the Gold and Platinum Plans. All Silver Plans share the same minimum health benefits but the way they charge out-of-pocket costs can differ significantly.
What Are The Silver Plan’s Out-of-Pocket Costs?
Based on an average person’s expected use of healthcare services, Silver Plans have the insurance company pay 70% of covered healthcare expenses. The remaining 30% of expenses are paid out-of-pocket by the policyholder. These out-of-pocket expenses include deductibles, copayments, and coinsurance. However, the plan’s monthly premium is not included as one of these out-of-pocket costs.
|Cost-Sharing Category||Average for a Silver Plan|
|Deductible for an individual enrollee||$2,907|
|Deductible for a family||$6,078|
|Preferred brand drugs||$47|
|Non-preferred brand drugs||$89|
|Specialty drugs||31% of specialty drug expense charged to patient as coinsurance fee (coinsurance fees used for specialty drugs in 62% of plans studied)|
|Annual cap on out-of-pocket costs for an individual||$5,730|
|Annual cap on out-of-pocket costs for a family||$11,495|
The table below illustrates how out-of-pocket costs can differ among three insurance companies that offer a Silver Plan.
|Silver Plan Example #1||Silver Plan Example #2||Silver Plan Example #3|
|Plan||Blue Cross & Blue Shield of Rhode Island - VantageBlue Direct 3000||Kaiser Foundation Health Plan - DHMO 2000/45 CA||Cigna - myCigna Health Flex 5000|
|Doctor Visit Fee||$20||$45||$30|
|Coinsurance Fee||20% of cost||20% of cost||$0 (after deductible is paid)|
|Annual Limit on Out-of-Pocket Expenses||$6,350||$6,350||$5,000|
As you can see in the table, deductibles and coinsurance can vary significantly among Silver Plans. Even though both Silver Plan examples cover 70% of medical costs, this coverage applies to the entire enrolled population. Some individual may receive more cost sharing and some less depending on the medical services used. The out-of-pocket costs also assume enrollees are using doctors and facilities approved by the plan. If you use a healthcare provider who is not approved, you could pay considerably higher costs and those costs might not apply towards the maximum out-of-pocket expenses you can pay in a calendar year.
There are also special versions of Silver Plans with lower out-of-pocket costs for people whose income qualifies them for enrollment. These Silver Plans are known as "Cost-Sharing Reduction" plans or CSR plans.
Tax Credit for Individuals & Families
The Affordable Care Act provides federal tax credits to people with middle incomes and low incomes whether they are buying individual or family insurance plans. The tax credit is based on the Silver Plan’s costs. If you are wondering what the tax credit is and how to determine if you are eligible then visit our Affordable Care Act Tax Credit page.
Silver Plan Premiums
Silver plans have the second lowest premium rates of the four new types of metal plans since they charge the second highest out-of-pocket costs. However, there may be instances where the Silver Plan of one insurance company may charge a lower premium than the Bronze Plan of another insurance company, as well as instances where the Gold or Platinum Plan of one insurance company may charge a lower premium than the Silver 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 Silver plans across 34 different states.
|Age 30||Age 40||Age 50||Age 60|
Silver Plan Enrollment Numbers
According to the Health and Human Services report for marketplace enrollment between October 1, 2013 and February 1, 2014, 62% of persons selecting a marketplace plan chose a Silver plan. For states running their own marketplaces, 58% of persons selecting a plan chose a Silver plan. For the federally-facilitated marketplace (FFM), 65% of persons selecting a plan chose a Silver plan. Specifically in the FFM 66% of females and 63% of males selecting a plan chose a Silver plan.
In terms of plan selection by age, 45% of persons selecting a plan in the FFM under the age of 18 chose a Silver plan. Moreover 67% of persons aged 18-25, 63% of persons aged 26-34, and 66% of persons aged 35- 44 selecting a plan in the FFM chose a Silver plan. Furthermore 67% of persons aged 45-54, 66% of persons aged 55-64, and 68% of persons at least 65 years old selecting a plan in the FFM chose a Silver plan.
Average Out-of-Pocket Costs for Silver Plans on the Small Business Market
The Affordable Care Act caps the deductibles on small business health plans for individual enrollees at $2,000 and for families at $4,000. However, in February 2013 the Department of Health and Human Services determined that in order to maintain the appropriate percentage of out-of- pocket costs for enrollees, small group health insurance plans used by businesses and other organizations were allowed to exceed the deductible caps. HealthPocket found the following average out-of-pocket costs for silver plans in the small business market.
|Cost-sharing category||Average for a Silver Plan|
|Medical deductible for individual enrollee||$2,384|
|Medical deductible for family||$4,946|
|Primary care visit||$34|
|Annual cap on out-of-pocket costs for an individual||$5,690|
|Annual cap on out-of-pocket costs for a family||$11,445|
The average deductibles for Silver plans exceeded both the $2,000 individual and $4,000 family deductible caps.
Frequently Asked Questions
How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee.
How much does a Silver Plan cost?
The monthly premium for a Silver 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 Silver Plan premiums in your area.
When Can I Enroll in a Silver Plan?
The first Open Enrollment period for the new Affordable Care Act health plans began October 1, 2013. Open enrollment this year ended March 31, 2014. The 2015 open enrollment period will be from November 15 to February 15. See our Open Enrollment article for more information.
What Is the Deductible Amount for a Silver Plan?
A deductible is the amount a consumer pays for covered medical services. HealthPocket found individual Silver plan medical deductibles were $2,907 on average in the individual and family market.
What does it mean when a Silver Plan is a benchmark plan?
A state insurance exchange uses the premium amount from a selected Silver Plan within the state to serve as the basis for subsidy calculations. The Silver Plan selected is the Silver Plan in the exchange with the second lowest premium. Even if a subsidy-eligible person chooses a Bronze, Gold, or Platinum plan, his or her subsidy amount is calculated based on the benchmark Silver Plan.
Do Silver Plans have more benefits than a Bronze Plan?
Silver Plans have the same benefit requirements as Bronze Plans. These benefit requirements are known as the Essential Health Benefits. An insurance company can choose the add benefits to a Silver Plan as well as any of the other new Affordable Care Act health plans. However, adding benefits are not required and does not distinguish a Silver Plan from a Bronze Plan, Gold Plan, or Platinum Plan.
Do Silver Plans cost more than Bronze Plans?
The answer is tricky. On average, Silver Plans should have higher premiums than Bronze Plans since Silver Plans pay a higher percentage of medical costs. However, prices vary among insurers and prices vary among regions so it is theoretically possible that there can be a specific Silver Plan that is less expensive than a specific Bronze Plan but this is expected to be an exception rather than the rule.
Can I get a Cost-Sharing Reduction (CSR) health plan that is not a Silver Plan?
No. CSR health plans are Silver Plans and enrollees must meet income eligibility criteria. To learn more, visit our Cost-Sharing Reduction (CSR) Health Insurance Page.
Will every insurer offer a Silver Plan?
On exchanges, every participating insurer offering products must include at least one Silver Plan and one Gold Plan. The same rules do not apply to carriers offering products outside of government exchanges.
If I qualify for a premium subsidy, do I have to purchase a Silver Plan?
No. You may apply your subsidy amount to any of the metal plans purchased on a state health insurance exchange. However, the premium subsidy amount is based on the benchmark Silver Plan.