Choosing a health care plan that fits your medical needs can save patients on annual doctor visits and prescription drug costs. When it comes down to picking what coverage is right for you, there are four different plan types to choose from under the Affordable Care Act: Bronze, Silver, Gold and Platinum. However, it is important to note that all plans must cover a certain percentage of the cost of prescription drugs and healthcare. They must also cover at least one drug in every category or class.
The plans are differentiated by the estimated coverage for total cost of care, or the total amount that the insurance company and individual are responsible for paying collectively for primary care visits, specialist care and prescription medication costs. To help determine which healthcare plan is right for you, consider preexisting conditions, the frequency of doctor visits, types of medications needed, or the risk for hospitalizations to avoid paying high out of pocket costs through the year.
Types of Affordable Care Act Health Care Plans
Affordable Care Act Coverage Pyramid
Bronze Plan: An average person under a bronze plan category can expect to pay 40% of total care, while the insurance company pays 60%. Individuals on this plan are responsible for paying higher deductibles for doctor visits and other out of pocket expenses like copayments for prescription medications. Generally, healthy individuals who do not expect to use many health care services throughout the year and do not require new brand name medications should possibly consider a Bronze plan, since it has the lowest monthly costs out of the plans available.
Silver Plan: Individuals covered on the silver plan will pay 30% of total care, while the insurance company pays 70%. Silver plans offer a balance between slightly higher monthly payments, but lower deductibles and copays for prescription medications. This plan is recommended for individuals with preexisting conditions that require one or more visits to primary care physicians or specialists, or require monthly generic medication treatments.
Gold Plan: Individuals under the gold plan can expect to pay 20% of their total healthcare costs, while the insurance pays 80%. Gold plans are recommended for patients who require monthly frequent primary care visits and advanced brand name prescription medication treatments. This plan requires patients to pay higher monthly payments and are usually recommended to older patients at high risk for hospitalizations. If you expect to visit doctors frequently, or require multiple prescription medication treatments, the Gold plan is a wise choice.
Platinum Plan: Under this plan patients pay 10% of the total healthcare costs, while the insurance company covers 90%. Platinum health coverage plans have the most coverage for specialist care and brand name medications; however, the monthly payments on this plan are much higher. Platinum plans are recommended for older patients with preexisting conditions that require multiple monthly doctor and specialist visits, along with multiple advanced medications or special treatments. If you are at risk for lengthy hospitalizations, a platinum plan can save you the most money during medical emergencies.
The prescription drug coverage across the affordable care act plan levels differ. If you are filling multiple brand name prescriptions every month, you should consider a Gold or Platinum plan to save money on those monthly costs. At HelpRx, we offer free drug discounts for everyone in the U.S. regardless of your health insurance coverage. Search our site to save on drugs that may be costly on your current health insurance plan.
