A Platinum Plan is a type of Affordable Care Act health insurance plan. A Platinum Plan is designed to incur the lowest out-of-pocket expenses among the four standard types of Affordable Care Act plans (Bronze, Silver , Gold, and Platinum). 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.
|Cost-Sharing Category||Average for a Platinum Plan|
|Deductible for an individual enrollee||$37 (2017 data)|
|Deductible for a family||$140 (2017 data)|
|Generic drugs||$8.79 (2017 data)|
|Preferred brand drugs||$31.89 (2017 data)|
|Non-preferred brand drugs||$58.43 (2017 data)|
|Specialty drugs||$92.46 (copay used for specialty drugs in 54% of 2014 plans studied) (2017 data)|
|Annual cap on out-of-pocket costs for an individual||$2,159 (2017)|
|Annual cap on out-of-pocket costs for a family||$4,318 (2017)|
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.
Insurance companies are not obligated to offer a Platinum Plan. To participate in a State Insurance Exchange they are only required to offer Silver Plans and Gold 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.
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.
A deductible is the amount a consumer pays for covered medical services. HealthPocket found individual Platinum plan medical deductibles were $37 on average.
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.
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.
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 plans can be obtained through the Federally-facilitated marketplace or a state-based marketplace (also referred to as on-exchange) or through a private insurance company (also referred to as off-exchange). The exchange status of a plan does not affect whether or not it covers the ACA’s minimum essential health benefit requirements, and all metal plans sold on- or off-exchange must meet these standards. Typically the benefits and cost-sharing for the same platinum plan (plan with same name for the same individual and rating area) purchased on- or off-exchange are the same. Premiums for the same platinum plan offered by the same insurer on- or off-exchange are also generally similar, if not the same.