Why Does the Silver Exchange Plan Matter?

Covered California heralded the era of the Metallics. It's not some futuristic forecast of shiny benefits but a reflection of the new Exchange health plans that are available (and mandated) to everyone effective since Jan 1st, 2014. There is a Platinum, Gold, Silver, and Bronze option available in the Exchange and off exchange. What do these names reflect in terms of level of benefit and why is the Silver specifically important to the California health insurance market?

Introduction to the Metallic Plans

First, what's the difference between the four levels? According to health reform, each State will choose a baseline health plan. California decided on the Kaiser $30 copay no-deductible small group plan as their baseline. Based on this, there are four core plans (and a more catastrophic plan for younger people) designed on "actuarial value". This is one of those lovely insurance terms that even people well versed in California health insurance have a difficult time explaining.

Actuarial value. What is that?

Basically, it's an approximation of benefit level according to how a plan might pay out for health claims. The platinum was given a 90% actuarial value of the Kaiser $30 copay plan mentioned above. This means that it is expected to pay out 90% of the claims that the Kaiser plan would pay out. The member would then pay out 10% more than what a member on the Kaiser plan would pay as an example. Since the Kaiser plan is a no-deductible, $30 copay plan, what does 90% really mean? The California Exchange offers these baseline Exchange benefits which you can quote side by side across the carriers.

So what about the other Metallic plans?

Gold will have an 80% actuarial value (no deductible). Silver will have a 70% actuarial value (a $2000 deductible, etc). Bronze will have a 70% actuarial value ( $4500-5000 deductible, etc). There are also differences in other other benefits such as doctor copays, prescription coverage, coinsurance, and max out of pocket but a lot of what must be included (Essential health benefits) is mandated by the law. For example, all plans will cover maternity. Our estimate is that most of these differences will be mute and the vast majority of enrollee in an exchange plan will go with the Silver option and here's why.

Have Silver, Will Subsidize.

For people whose Income estimate is between 138% and 250% of the Federal Poverty Level (you can see the Covered Ca income grid here), they will not only receive a large tax credit towards their choice of plan but they will be eligible for the Enhanced Benefit.

This means they will get richer benefits on the Silver plan for the same price as the standard Silver 70

This is a huge deal and accounts for why the vast majority of new Covered California enrollees go with the Silver plan. Calculating the income, household size, and various requirements can be complicated on your own. Have no fear.

We can quickly size up your expected tax credit generally in 5 minutes so that you get most tax credit your available for and the Enhanced Benefit if possible. As Certified Covered

California Agents, there's no cost for this service. Call 800-320-6269 to find out what you're eligible for.

You can run your Covered Ca Health Plan Quote here to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!