Platinum Plan – Affordable Care Act (Obamacare)
- Platinum plan out-of-pocket costs
- Platinum plan premiums
- Platinum plan benefits
- Platinum plan enrollment numbers
- Platinum Plans On-Exchange vs. Off-Exchange
- Average out-of-pocket costs for platinum plans on the small business market
- Frequently asked questions
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 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.
Platinum Plan Out-of-pocket Costs
|Cost-Sharing Category||Average for a Platinum Plan|
|Deductible for an individual enrollee||$233|
|Deductible for a family||$468|
|Generic drugs||$7 (2014 data)|
|Preferred brand drugs||$31 (2014 data)|
|Non-preferred brand drugs||$61 (2014 data)|
|Specialty drugs||$126 (copay used for specialty drugs in 54% of 2014 plans studied)|
|Annual cap on out-of-pocket costs for an individual||$2,403|
|Annual cap on out-of-pocket costs for a family||$4,806|
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 a State Insurance Exchange they are only required to offer Silver Plans and Gold Plans.
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 30||Age 40||Age 50||Age 60|
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
The below table contains data released by the Department of Health and Human Services (HHS) regarding marketplace enrollment from November 15, 2014 through February 15, 2015. For each age group the percent of platinum total represents the proportion of individuals who selected a platinum plan that were in the age group. The percent of age group total represents the proportion of individuals in the age group who selected a platinum plan.
|Age Group||Number of Individuals that Selected a Platinum Plan on FFM||% of Platinum Total||% of Age Group Total|
|Age Under 18||35,230||16.00%||5.00%|
|Age 65 or Over||978||0%*||2.00%|
*0% due to few seniors choosing a platinum plan and rounding
Platinum Plans On-Exchange vs. Off-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.
Average Out-of-Pocket Costs for Platinum Plans on the Small Business Market
The Affordable Care Act required deductibles for small business plans 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 2014 platinum plans in the small business market. No platinum plans exceeded the deductible caps.
|Cost-sharing category||Average for a Platinum Plan|
|Medical deductible for individual enrollee||$323|
|Medical deductible for family||$647|
|Primary care visit||$16|
|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 Open Enrollment period for Affordable Care Act health plans begins November 1, 2015 and continues through January 31, 2016. 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 $243 on average.
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.