Obama Care Plans and Prices

Find Bronze, Silver, Gold and Platinum Obama Care Plans and Prices

When the Affordable Care Act (ACA) became law, health insurance plans where repackaged, and categorized into 4 metal tiers: Bronze, Silver, Gold and Platinum. Covered California took this a step further and streamlined all the plans they offered on-exchange, so they became a real “apples to apples” comparison.

The silver tier is the most popular, so using it as an example, if you were looking at all the Silver 70 plans on the Covered California marketplace, there would be no plans benefit differences. You would only have to decide which carrier you want, and whether you want an HMO, EPO, PPO or HSP. These acronyms represent the type of network you would have access to and essentially which doctors, and hospitals accept your insurance.

bronze

Price: $

Popularity: starstarstarstar

Deductible: $6,300 Individual
$12,600 Family

Doctor Visits: 1st 3 Visits $75-$105

Generic Drugs: Full price up to $500 per script after drug Ded

Hospital: Full price up to OOP Max

OOP Max: $6,800 Individual
$13,600 Family

Estimated Avg Medical Costs

Insurance Company pays:
60%

You Pay: 40%

more info

silver

Price: $$ and less

Popularity: starstarstarstarstar

Deductible: $2,500 Individual
$5,000 Family

Doctor Visits: $35 – $70

Generic Drugs: $15

Hospital: 20% after deductible up to OOP Max

OOP Max: $6,800 Individual
$13,600 Family

Estimated Avg Medical Costs

Insurance Company pays:
70%

You Pay: 30%

more info

gold

Price: $$$

Popularity: star

Deductible: None

Doctor Visits: $30 – $55

Generic Drugs: $15

Hospital: $600 per day up to 5 days (most HMO’s)
20% (PPO, some HMO’s)

OOP Max: $6,750 Individual
$13,500 Family

Estimated Avg Medical Costs

Insurance Company pays:
80%

You Pay: 20%

more info

platinum

Price: $$$$

Popularity: starstar

Deductible: None

Doctor Visits: $15

Rx: $5

Hospital: $250 per day up to 5 days (HMO)
10% (PPO)

OOP Max: $4,000 Individual
$8,000 Family

Estimated Avg Medical Costs

Insurance Company pays:
90%

You Pay: 10%

more info

 

The metal plans categories help identify how much you would pay of estimated average medical costs, compared to how much the insurance company pays. It has nothing to do with the quality of care given.

All plans include the 10 Essential Health Benefits that are required to be covered by law.

  1. Ambulatory patient services (outpatient)
  2. Emergency Services
  3. Hospitalization
  4. Maternity and newborn care
  5. Metal health and substance use disorder services (including behavior health)
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including some dental and vision care (included for children only)

Below you will see a summary of the 4 metal tiers along with the minimum coverage plan.

 

 

bronze

Price: $

Popularity: starstarstarstar

Deductible: $6,300 Individual
$12,600 Family

Doctor Visits: 1st 3 Visits $75-$105

Generic Drugs: Full price up to $500 per script after drug Ded

Hospital: Full price up to OOP Max

OOP Max: $6,800 Individual
$13,600 Family

Estimated Avg Medical Costs

Insurance Company pays:
60%

You Pay: 40%

Bronze 60 Plan

Best For: 
A healthy individual/family that does not have medical conditions, but wants insurance just in case something major happens

Features:

  • Free preventative care
  • First 3 office visits are a fixed copay (dollar amount) before deductible is reached
  • High deductible
  • Out-of-pocket maximum limit; which is the most you would pay in a calendar year if the worst happened.

 

Bronze HDHP (High Deductible Health Plan) 60 Plan: 

Best For:
A healthy individual/family that wants to take advantage of tax savings, and plans on putting money into a special bank account called a Health Savings Account. This money can be used for medical expenses and the money roles over from year to year.

This is considered a major medical health plan so it would be good for someone who wants catastrophic coverage. In addition, those that prefer alternative medicine find this an attractive option as many of the services can be paid for with money from an HSA. Check the IRS publication 502 as to what medical services are eligible.

Features:

  • Free preventative care
  • High deductible, but lower than the standard Bronze 60
  • Out-of-pocket maximum limit; which is the most you would pay in a calendar year if the worst happened. The out-of-pocket maximum would be a little lower the standard Bronze 60 plan above.

 

 

silver

Price: $$ and less

Popularity: starstarstarstarstar

Deductible: $2,500 Individual
$5,000 Family

Doctor Visits: $35 – $70

Generic Drugs: $15

Hospital: 20% after deductible up to OOP Max

OOP Max: $6,800 Individual
$13,600 Family

Estimated Avg Medical Costs

Insurance Company pays:
70%

You Pay: 30%

Silver 70 Plan

Best For:
A healthy individual/family who want an affordable middle of the road Obama Care plan that offers reasonable copays for common services such office visits, lab work, and generic drugs

Features:

  • Free preventative care
  • Common services such as doctor visits, lab work, generic drugs, and emergency room visits for a set copay (dollar) amount without having to meet your deductible first.
  • Mid-range deductible for major services such as outpatient surgery, hospitalization, etc.
  • Out-of-pocket maximum limit; which is the most you would pay in a calendar year if the worst happened.

 

 

 

 

 

 

 

 

 

 

gold

Price: $$$

Popularity: star

Deductible: None

Doctor Visits: $30 – $55

Generic Drugs: $15

Hospital: $600 per day up to 5 days (most HMO’s)
20% (PPO, some HMO’s)

OOP Max: $6,750 Individual
$13,500 Family

Estimated Avg Medical Costs

Insurance Company pays:
80%

You Pay: 20%

Gold Plan

Best For: 
A healthy individual/family that frequently uses medical services and/or wants an Obama Care plan without a deductible

Features: 

  • Free preventative care
  • Copays (fixed dollar amounts) for medical services if you select the Gold 80 Copay plan, or coinsurance (a percentage of the medical costs) if you select the Gold 80 Coinsurance plan.
  • No deductible
  • Out-of-pocket maximum limit; which is the most you would pay in a calendar year if the worst happened.

 

 

 

 

 

 

 

 

 

 

platinum

Price: $$$$

Popularity: starstar

Deductible: None

Doctor Visits: $15

Rx: $5

Hospital: $250 per day up to 5 days (HMO)
10% (PPO)

OOP Max: $4,000 Individual
$8,000 Family

Estimated Avg Medical Costs

Insurance Company pays:
90%

You Pay: 10%

Platinum Plan

Best For:
A healthy individual/family that frequently uses medical services, wants the best Obama Care plan available with the least out of pocket costs. Deductible: None

Features:

  • Free preventative care
  • Copays (fixed dollar amounts) for all medical services
  • No deductible
  • Lowest out-of-pocket maximum limit (most you would pay in a calendar year if the worst happened) available of all the Obama Care plans offered.

 

 

 

 

 

 

 

 

 

Minimum Coverage Plan

Best For:
A healthy individual/family who is 30 years old or under, does not qualify for premium assistance, and whose main concern is affordability

Important to Note:
Government assistance (subsidies) cannot be applied in reducing the premiums for this plan. It is available only to those 30 and under as well as those who meet the hardship exemption.

Features:

  • Free preventative care
  • First 3 office visits are free
  • Highest deductible compared to the Bronze 60 or Silver 70
  • Highest out-of-pocket maximum limit (most you would pay in a calendar year if the worst happened) of all the Obama Care plans offered