Affordable Care Act
What Is a Gold Health Insurance Plan?
Updated on October 13, 2022
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A gold health insurance plan is a type of individual & family health insurance policy that covers 80% of covered health care costs with the policyholder paying the remaining 20%. The percentage you’re responsible for consists of the deductible, copayment and coinsurance payments. It’s one step below a platinum healthcare plan, and typically covers more healthcare services than a silver or bronze plan.
As a general rule, a gold health plan costs more than silver or bronze, but they can sometimes cost the same as the lower tiers due to cost-sharing reductions. You may be able to get gold health insurance for the price of silver. Gold plans also tend to have lower out-of-pocket costs, which can be more cost-effective overall, even though they may have a higher health insurance premium.
Read on to learn more about what gold medical insurance is, how much it costs on average, and if a gold plan is right for your healthcare needs.
Gold health insurance plans vs. other metal levels
The four levels of health insurance are known as the metal levels. They include:
- Bronze
- Silver
- Gold
- Platinum
The bronze metal level offers basic health coverage with the lowest split between insurer and insured, while platinum has the most coverage available and the highest split. More information is available from the Affordable Care Act resources page. Here’s a look at what to expect from each metal level.
Bronze plan
The bronze level is also the least expensive of all the levels and has a 60/40 split for coverage after the deductible has been met. Bronze plan deductibles are also high. This type of plan is a step above catastrophic coverage and is best for those who want health care coverage for worst-case scenarios.
Silver plan
A silver level plan has a higher monthly premium than the bronze level and offers more coverage with lower costs. The split for coverage on silver plans is 70/30. Deductibles tend to be lower as well, and if you qualify for cost-sharing reductions, you can save even more money on your medical care. However, the cost-sharing reductions are available at the silver level only.
Gold plan
A gold plan tends to have a high monthly premium, but it can also cost the same as a silver plan in some areas. These plans have lower deductibles and lower costs of healthcare. The cost split for a gold plan is 80/20.
Gold health plans typically have high monthly premiums but lower medical care costs
Platinum plan
The platinum level is the most expensive of all the plans, and provides the most coverage for healthcare. The deductibles are the lowest, and the cost split is 90/10. A platinum plan makes the most sense for those who need ongoing healthcare and want the assurance that almost all costs are covered.
How much is a typical gold health insurance plan?
How much you pay for gold health insurance depends on your current state of residence. The average cost of gold medical insurance in 2022 is $462 across all 50 states according to the Kaiser Family Foundation. Some states are more expensive, while others are less. For example, the average cost in Illinois for a gold plan is $464, $839 in Virginia, and $296 in Maryland. The costs for gold plan premiums are dropping quickly, which indicates that the tax credit covers more of the premium cost than in years past.
The average premium for a gold plan in the marketplace is $462 in 2022
How much is an average subsidy for a gold health insurance plan?
The average subsidy for a gold health insurance plan depends on a number of factors. The subsidy, also known as the advanced premium tax credit, is a deduction you can apply for during Open Enrollment. It’s worth noting that the tax credit is not automatically applied, and the amount you receive is based on the income information you enter into the application.
You have the option to take the credit as a monthly payment towards your premium, or pay the premium in full and deduct the cost of your premiums on your income taxes. The average subsidy for a 30-year-old individual making 150% of the federal poverty level (FPL) ($20,385) is $342 per month, while someone making 300% of the FPL ($40,770) will receive a subsidy of $149 per month.
The cost of a gold plan for someone at 150% of the FPL is $120 per month, and $313 for someone earning 300% of the FPL.
As you look into the question of “how much is gold health insurance?”, you’ll find it’s based on your income and the federal poverty level multiplier. The multiplier is anywhere from 150% to 400% of your income. Typically, the less you make, the higher the multiplier.
What are the other costs associated with a gold health plan?
Whether you want to choose a gold or a different metal level, it is important that you think about the total health costs. This means that you need to consider more than your monthly premium when you choose your insurance plan. For example, you should consider out of pocket expenses, as well as the list of following potential costs.
- Copayments — The payments that you need to make each time you receive a medical service after you have reached your deductible are referred to as copayments.
- Deductible — The deductible is the amount of money that you will need to spend on covered medical services before your insurance provider will begin to cover the costs. Preventive services are often the exception to the later rule, whereby these services will often be paid for in your gold health plan.
- Out of pocket maximum — This payment refers to the most amount of money that you will spend in covered medical services for an entire year. Once you have reached your deductible your insurance provider will often pay for 100 percent of covered medical expenses.
Is a gold health insurance plan worth it?
Gold medical insurance is worth getting if you need comprehensive medical care for an extended period of time. You’ll save money on your medical care and prescriptions as well as the cost of seeing specialists. Premiums for a gold health plan are high, but when you compare them to out-of-pocket costs for silver and bronze plans, a gold health plan winds up being economical. Gold health plans have also become less costly in recent years due to cost-sharing reductions.
A gold health plan is not worth it for someone who has good health and doesn’t require frequent medical care. You may not need the type of coverage offered by gold medical insurance, resulting in you spending more money on premiums for coverage you won’t be able to benefit from.
Find a gold health insurance plan with eHealth
Once you have compared the features of metal levels and reviewed the costs, you can decide if a gold health insurance plan is right for you. To answer this question, you will need to review your anticipated medical needs for the upcoming year, and eHealth makes this easier by offering quotes on health insurance plans for free. For example, if you expect to have a lot of doctor visits, and anticipate needing regular prescriptions throughout the year, then the gold health plan will probably be the right choice. In conclusion, it is important that you take your time reviewing all of the available health insurance plans before deciding if the gold health insurance plan is right for you.