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
National

California passes 'yes-means-yes' campus sexual assault bill

Californian lawmakers passed a law on Thursday requiring universities to adopt "affirmative consent" language in their definitions of consensual sex, part of a nationwide drive to curb sexual assault on…

National

Syrian refugees top 3 million, half of all…

By Stephanie NebehayGENEVA (Reuters) - Three million Syrian refugees will have registered in neighboring countries as of Friday, but many remain trapped by the advance…

International

North Korean leader's money manager defects in Russia:…

A senior North Korean banking official who managed money for leader Kim Jong Un has defected in Russia and was seeking asylum in a third country, a South Korean newspaper…

Local

MAP: New York City Street Closures August 29,…

The Department of Transportation and NYPD said there may be residual delays near all of the street closures on August 29, 31 and 31. Several streets and avenues will be…

Going Out

'Friends' coffeehouse Central Perk coming to NYC —…

"Friends" is coming back for a one-off special: "The One with the Free Coffee." Warner Bros. is bringing a pop-up replica of Central Perk, the…

Movies

Interview: 'As Above, So Below' directors: 5 ways…

The fraternal directors of the found footage horror "As Above, So Below" dish on the best ways to frighten the bejesus out of audiences.

Movies

Criterion's new Jacques Demy box mixes the light…

Jacques Demy, the most effervescent of French New Wave filmmakers, gets a Criterion box all to himself, with classics like "The Umbrellas of Cherbourg."

Entertainment

Comedian Joan Rivers, 81, rushed to New York…

NEW YORK (Reuters) - Acerbic comedian and fashion critic Joan Rivers was rushed to Mount Sinai Hospital in New York on Thursday after she reportedly…

NFL

3 things we learned in the Giants preseason…

The final score didn’t matter — a 16-13 win by the Giants — but it would’ve been nice to finally see Big Blue’s new-look offense get on track.

NFL

NFL Power Rankings: Seahawks, Broncos, Patriots, 49ers start…

NFL Power Rankings: Seahawks, Broncos, Patriots start at top

U.S. Soccer

5 facts about new England captain Wayne Rooney

Manchester United striker Wayne Rooney was named as the new England captain by coach Roy Hodgson on Thursday.

NFL

Jets vs. Eagles: 3 things to watch

A win on Thursday night at the Eagles would give the Jets a 3-1 record and just their second winning preseason under head coach Rex Ryan.

Style

Trend: White hot on the 2014 Emmy's red…

White was one of the big trends on the Emmy's red carpet.

Food

Recipe: Samuel Adams beer-marinated grilled shrimp

Summer calls for two things: a cold beer and light food. Sam Adams' Latitude 48 IPA fairly bursts with citrus notes, making it an ideal marinade…

Wellbeing

4 healthy ingredient swaps to make your meals…

When it comes to eating well, everyone knows they could be doing better. But cooking in an apartment on a busy schedule is a recipe…

Wellbeing

Heart trumps brain when it comes to movies…

When you need a good cry, do you reach for the movie that’s “based on a true story”? Science says you’re giving your brain far…