A look at the California Metallic health plans
First, some pointers on reading the plan benefits since there are a few layers of complexity on top of just standard benefits. We'll provide guidance based on what we know now which will definitely change going forward. There are 4 basic plan types and one catastrophic plan for younger people under age 30. The four basic plans are Platinum, Gold, Silver, and Bronze in decreasing benefit and cost. If you see a "SHOP" at the top of the benefit matrix, that means the plan is available for group health insurance in California. If you see "Individual", that means it is available for Individuals and Family (as opposed to group health coverage).
The plans are standardized at each metallic level. For example, a Bronze plan will have the same benefits across the different carriers and networks (HMO, PPO, etc). There are three main areas to focus on (aside from the monthly premium). The deductible, the Out-of-pocket Max, and the copays. Really, the deductible and max are where you'll see big swings up and down the levels. Deductibles are $5000, 2000, 0, and 0 going down the scale. The max is actually the same for the bronze, silver, and gold plan. Therefore, the platinum is really for people expecting very large medical expenses.
Income is the key driver of everything now.
It affects how much you'll pay and even if you'll get richer benefits as part of the Enhanced Silver plan options. The 100%-150% means that you make between 100% and 150% of the Federal Poverty Levels. Due to this income level, you will get richer benefits than someone making 150%-200%, 200-250% of poverty. This is in addition to subsidies that you will receive up to 400% towards the monthly health insurance premium. The subsidy qualified health plans are very rich by today's standard. We haven't seen plans like those in 10 years.
A few important considerations. We still have
California HSA options which is great news. The
benefits are very very rich on everything but
the Bronze plan which means that the vast
majority of those without a subsidy will stay
with a grandfathered plan or choose the Bronze.
In the Exchange, the Silver and Bronze reign due
to cost considerations and the fact that no
carrier wants to offer the best Platinum plan on
the market (adverse selection). Even with
subsidies, the rates will be so high on the
richer plans that many people may move down in
benefits as well. Keep in mind that you have to
make very little to qualify for a subsidy at
138-150% so cost is still the main concern even
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|Single Person:||$16k - $47k|
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|3 People||$27k - $80k|
|4 People||$33k - $97k|
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