Affordable Care Act
What Is a Platinum Health Plan?
Updated on October 18, 2022
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The health plans offered under the Affordable Care Act (ACA) are categorized into different metal levels based on the cost and level of coverage offered. The Platinum health plan is the highest level plan and results in the insurance company paying the highest share of medical costs. However, this generous coverage is paired with a higher price tag than the one that comes with other plans. Whether a Platinum health plan is the right one for you depends on a number of factors related to your health, your income, and your anticipated need for medical services.
What is the Platinum health plan?
Platinum is the highest of the four health plan metallic levels under the ACA; the other three are Bronze, Silver, and Gold. While a Platinum health plan offers the lowest out of pocket costs when medical services are needed, it also comes with a premium that is significantly higher than those associated with other plans.
What does a Platinum health plan offer?
As with every ACA-compliant plan, a Platinum health plan must offer 10 services that are deemed essential coverages. These include:
- Prescription medication coverage: most plans have a flat out-of-pocket fee for prescription drugs covered by the health plan
- Preventive care, wellness checks, and chronic disease management
- Emergency health care and services
- Pediatric health care coverage: a Platinum health plan for minors must include dental, vision, and medical coverage
- Hospital stays: even with a Platinum health plan, there will often be out-of-pocket costs associated with hospitalization
- Mental health coverage and addiction care
- Pregnancy and maternity coverage; the health plan will also cover newborn care
- Ambulatory services: procedures that are performed on an outpatient basis, such as some minor surgeries
- Lab services: tests performed for diagnosing potential health issues.
- Rehabilitative services and devices: includes assistive devices like crutches, as well as health services, such as physical therapy
In most cases, there is a copay or coinsurance payment before the policyholder’s share kicks in. However, certain health services are fully covered without any additional cost to the patient. These include a number of preventive care services. These can include the following:
- wellness check-ups
- immunizations, including the flu shot
- diagnostic screenings like blood pressure checks, lung cancer screenings and mammograms
- preventive medicine such as aspirin to reduce heart attack risk or statins to lower blood pressure
- fall prevention for people who are over the age of 65
Additionally, your plan may offer other coverage at their option. Look at plan details through a licensed broker like eHealth to learn more and compare health insurance plan options.
How much does a Platinum health insurance plan cost?
A platinum medical plan will offer a higher percentage of coverage than any other kind of plan. Last year, the average cost of a platinum plan for a 40 year old was $709 per month. In that same survey, the average deductible came out to $459. Certainly, this is more than many people are willing or able to pay. But, if you can afford it, a platinum plan could be especially be well worth it for people aged 40 and older.
Keep in mind that your age, the state you live in, and your habits will have a significant effect on your health insurance costs no matter what type of plan you choose. Whether you choose individual or family health plans will also affect your premiums.
Does the Platinum health plan come with a subsidy?
If you qualify for a healthcare premium subsidy, you can use it to defray the costs of a Platinum health plan. However, the subsidy amount will cover a smaller portion of your premium cost than if you had a lower tier plan. This is because the subsidies are linked to the average cost of a Silver health plan in your market.
Platinum health plan advantages and disadvantages
Naturally, every health insurance plan will come with its pros and cons. In most cases, the advantages and disadvantages will come in the form of cost versus coverage. The more you pay, generally, the more will be covered.
Platinum health plan advantages
You should choose a Platinum health plan if a lower out-of-pocket platinum health insurance cost is your greatest concern and you want a lower copayment. If you expect to use your health coverage policy frequently, a Platinum plan might be the best choice. If you use your health insurance frequently, take a close look at the out-of-pocket maximum of the plan. If you know that your out-of-pocket expenses will exceed the maximum, you could save money by selecting a lower-level plan.
Platinum health plan disadvantages
If the high monthly premiums are outside of your budget, then a platinum plan is not a good fit for you. Platinum plans are optimized for those who need to use their health insurance frequently and can afford a higher standard of care. If you are approaching seniority or are dealing with a chronic condition, a Platinum plan may serve you well.
For more options, consider looking through the available Affordable care act resources.
How much will a Platinum health plan pay?
As a rule, all of the health plan metal levels add up to a different percentage of the cost of medical care. Healthcare.gov estimates the average percentages as the following:
| Plan Category | The insurance company pays | Insured pays |
| Platinum | 90% | 10% |
| Gold | 80% | 20% |
| Silver | 70% | 30% |
| Bronze | 60% | 40% |
Who should have a Platinum health plan?
Of all four metallic health plan levels, Platinum covers the highest percentage of medical costs. Someone who expects to use a great deal of health care services may find that it is more economical to opt for a Platinum health plan. While the initial premium is far higher than other options, the peace of mind of knowing that out-of-pocket expenses for care are covered can provide significant peace of mind.
The right health plan tier for you is a highly personal decision that is influenced by a number of factors. If you are having trouble making a decision, we can help. eHealth can provide information about a number of health coverage options and help you identify the one that will serve you best.
Find the right health plan tier for you
Choosing a health insurance plan is a big decision. Your healthcare needs, those of your family, your budget, and other considerations must be weighed carefully. The best plan for you will be based on your medical needs and what you can afford.
Platinum health insurance plans give you reliable coverage for a wide range of healthcare costs, and they come with a long list of options. It is a good idea to look at the plan you are considering over carefully with a health care insurance professional. A good healthcare insurance consultant will help you sort through the legalese you will find in the policies and contracts you will see. At the end of the day, if you opt for a Platinum health insurance plan, you can rest in the certainty that you have made a wise decision for yourself and your family. Here at eHealth, our team of expert health insurance professionals takes pride in offering transparent policies and high level advice to all of our customers. To learn more, and find a health insurance plan that suits your needs and your budget, get in touch with eHealth today. Our consultants are eager to take your call.