|Applicant||2/23/1985 Male |
|Insurance Type||ACA (Obamacare)|
|Plan Name||UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network|
|Insurance Provider||UPMC Health Plan|
Costs for Medical Care
|Primary Care Visit to Treat an Injury or Illness||$20 Copay|
|Specialist Visit||10% Coinsurance after deductible|
|Deductible - Family||$500|
|Out-of-Pocket Maximum - Family||$3000|
Prescription drug coverage
|Generic Drugs||$10 Copay|
|Preferred Brand Drugs||$45 Copay|
|Non-Preferred Brand Drugs||$90 Copay|
|Specialty Drugs||50% Coinsurance after deductible|
Access to doctors and hospitals
|Provider directory URL||https://www.upmchealthplan.com/marketplace/network.aspx?network=2018_132_IND_PPO_Serv1_Med42_DPPO|
|Emergency Room Services||10% Coinsurance after deductible|
|Inpatient Hospital Services (e.g., Hospital Stay)||10% Coinsurance after deductible|
|Inpatient Physician and Surgical Services||10% Coinsurance after deductible|
ObamaCare’s Platinum Plan is a type of Metal Plan on the Health Insurance Marketplace. Platinum Plans qualify for Tax Credits and have the highest premiums. A Platinum Plan is designed to incur the lowest out-of-pocket expenses for enrollees. A typical platinum plan enrollee pays approximately 10% of the costs of covered healthcare services with the plan paying the remainder. In comparison, a typical Bronze Plan enrollee pays 40% of covered medical expenses.
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.
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.
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).