Explaining the Affordable Care Act: What do the different health coverage tiers mean?

Get Covered America buttons are seen during a training session in Chicago, Illinois September 7, 2013 before volunteers canvas a Chicago neighborhood to talk with residents about the Affordable Care Act - also known as Obamacare. Credit: Reuters
Get Covered America buttons are seen during a training session in Chicago on Sept. 7 before volunteers canvas a neighborhood to talk with residents about the Affordable Care Act — also known as Obamacare.
Credit: Reuters

Every week, Archelle Georgiou, MD, Strategic Advisor at Healthgrades, will explain one facet of the Affordable Care Act.

Bronze, Silver, Gold and Platinum: What’s the difference in these new health plan coverage tiers?

Unlike with jewelry, these descriptors don’t reflect the quality of insurance coverage. All plans offer coverage for all essential benefits mandated by the Affordable Care Act, such as preventive care, hospitalization and mental health care.

The difference is financial. The tiers refer to the share of health care expenses the insurer expects to cover for its aggregate group of enrollees. Bronze plans pay roughly 60 percent of the cost, Silver 70 percent, Gold 80 percent, Platinum 90 percent. These percentages are actuarial, meaning each individual’s responsibility may vary.

The level of financial coverage for an individual can differ across plans since the mix of deductible, co-pay and co-insurance will vary, even among plans within the same tier. For example, one Silver plan may have a higher deductible than another but lower co-payments. Yet another Silver plan could have a lower deductible but a higher percentage of co-insurance for hospital care.

To select the best plan for your financial needs, understand the four components of your total health insurance costs: premium, deductible, co-payment and co-insurance. Your premium is the monthly fee that must be paid regardless of whether or not health care services are used. Your deductible is the amount that must be paid out of pocket before insurance starts to pay for coverage. Co-insurance is the percentage of the cost of a health care service that the individual pays (after the deductible is met). This is different from a co-pay, a flat fee for a certain service.

The bottom line is that your level of coverage depends on how much and what type of health services you use.

Every week, Archelle Georgiou, MD, clinical adviser at Healthgrades, will explain one facet of the Affordable Care Act.


News
Entertainment
Sports
Lifestyle
Local

Memorial held for Sean Collier, MIT police officer…

More than 1,600 people gathered at MIT on Friday for a memorial service for Sean Collier, the police officer shot to death a year ago in the aftermath of the…

National

Florida man charged with murdering son to play…

A Florida man annoyed that his 16-month-old crying son was preventing him from playing video games suffocated the toddler, police said on Friday.

International

Powerful 7.2 magnitude earthquake rattles Mexico

A powerful earthquake struck Mexico Friday, shaking buildings and sending people running into the street, although there were no reports of major damage.

News

OMG! Exercise can make skin (and butt) look…

A moderate exercise regime can turn back time and actually reverse the skin's aging process, according to new research. The study showed that a minimum…

Entertainment

Whoopi Goldberg makes her debut as marijuana columnist

"It helps my head stop hurting, and with glaucoma your eyes ache, and she takes the ache out. It's wonderful," she said.

The Word

Kate Middleton made fun of Prince William's bald…

Kate Middleton and Prince William are in Sydney, Australia, right now, and it sounds like that brash Aussie sense of humor might be rubbing off.

The Word

Is Tom Cruise dating Laura Prepon?

"Mission: Impossible" star Cruise is said to be dating Laura Prepon, star of "Orange is the New Black."

Television

'Scandal' recap: Season 3, Episode 18, 'The Price…

Sally is Jesus, Olivia caused global warming, and Mellie's still drunk. Let's recap the Scandal finale. A church full of Washington insiders is about to…

NHL

NHL video highlights & analysis: Red Wings dump…

NHL video highlights & analysis: Red Wings dump Bruins in Game 1

MLB

MLB video highlights: Orioles top Red Sox, 8-4…

John Lackey roughed up for second straight outing

MLB

MLB video highlights: Red Sox score two in…

Lester shines in Red Sox win over White Sox

Sports

2014 Boston Marathon preview: Elite American, International runners…

2014 Boston Marathon: Elite American, International runners to watch

Tech

VIDEO: 'Vein-scanning' may become the future of paying

Designed to make transactions quicker and easier, the technology works by scanning the unique vein patterns in each person's palm.

Tech

#FollowFriday: 10 of the smartest Twitter accounts

Spending lots of time on Twitter? You might as well learn something. Here are some of the smartest accounts to follow.

Style

Light-up nail art syncs with phone

This Japanese technology syncs light-up nail art with your phone.

Wellbeing

Why is dance cardio taking off in NYC?

Instructors at some of the city's hottest classes explain why.