ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Other Metal Plans include Bronze, Silver, and Platinum. Also a Catastrophic Plan is available to young adults and to some people with hardship exemptions.Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.
Gold Plans, 80% Average Cost Sharing… But Higher Premiums
Gold plans provide an average cost sharing value (known as Actuarial Value AV) of 80%. This means that a Silver plan must cover an average of 80% of all that plans enrollees covered out-of-pocket costs. This does not mean that 80% of actual costs will be covered for any one given person. In fact, a small minority of policy holders will account for the majority of costs. So actuarial value should always be looked at as a sign of how good a plan’s cost sharing is, not as a literal amount. In some states Gold plans must meet additional criteria, making cost sharing offered on these plans even more attractive.
Of course with better cost sharing, comes higher premiums.
Gold Plans and Subsidies
You can use Tax Credits to lower your premium on Gold Plans. However you won’t get as much assistance as you will on Bronze or Silver plans.
Should I Get a Gold Plan?
If you or your family will use a lot of Medical services and you don’t qualify for Cost Sharing Reduction subsidies then a Gold plan could be a smart buy. When we are looking at health insurance costs, we don’t just look at premiums, we look at total medical spending in a year. Since Gold plans have better cost sharing and lower deductibles and maximums on average, you could end up saving annually with a Gold plan.
Be aware, it can be a mistake for a healthy person to get a high premium plan. Health insurance isn’t about getting the most expensive plan. It’s about getting the care you need for the best cost in a given year. Unlike with some things in life, paying more for health doesn’t always equate to “better”.
All Plans Provide Minimum Coverage
All plans must provide minimum benefits, minimum protections, and minimum value. No matter what plan you choose you’ll get a free wellness visit, free preventive care, and won’t be out more than your maximum in an emergency. Gold plans will typically offer more than minimum in terms of benefits and will often offer even better than the minimum cost sharing amounts to attract customers.
Do I Have to Use the Marketplace?
If you want cost assistance, you have to get a Marketplace plan. However, a qualified health insurance agent, broker, or provider can help you shop for Marketplace plans they offer.