Healthcare Reform and the 4 levels of Coverage: Part 2 of the Healthcare Reform Series
By: Robert Pusateri November 2013
There will be 4 levels/categories of Health Insurance coverage offered in the state of Nevada: bronze, silver, gold and platinum. Each level of coverage will meet the Essential Health Benefits and will not reflect the quality or amount of care the plans provide. The category WILL however affect the premium cost each month and out of pocket expense (portion of the bill an individual will be responsible to pay). The level/category will also affect the amount an individual pays for prescription medications. The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs —the total amount you’ll spend for the year if you need lots of care.
The metal tier will vary by percentage of costs you have to pay out of pocket on average toward the health care you receive as follows:
• Bronze Plan: 40% (out of pocket), Least expensive monthly
premium
• Silver Plan: 30% (out of pocket), Lower monthly premium
• Gold Plan: 20% (out of pocket), higher monthly premium
• Platinum Plan: 10%(Out of pocket), Highest monthly premium
To better understand, A Bronze Plan will have the lowest monthly premium but highest out of pocket expense for someone having a procedure done. Prescriptions will also be the most costly on this plan. This level would be good for someone who does not anticipate going to the doctor much through the year but needs to have minimum coverage to stay in compliance.
A Silver Plan will have a lower monthly premium but will not require as large of out of pocket expense if any procedures have to be done. Prescriptions will be of higher cost. This level would be good for most individuals who are anticipating average doctor visits, moderate prescription use and no major procedures.
A Gold Plan will be a higher monthly premium but moderate out of pocket expense for someone having a procedure done. Prescriptions would have a lower-moderate cost. This would be a good plan for an individual who anticipates more doctor visits and some procedures, and some amount of prescription activity.
A Platinum Plan will have the highest monthly premium but lowest out of pocket expense for someone having a procedure done. Prescriptions will also be the least costly on this plan. This level would be good for someone who is going anticipating a lot of doctor visits, a major procedure or has a lot of higher priced prescriptions that need to be covered.
There is one other level that will be offered to those under 30 years of age and it is the catastrophic plan.
In conclusion, a person with a silver plan will pay a different amount for the same service then a person with a platinum plan. A person on a silver plan will pay less per month for insurance but more for a surgery then a person on a platinum plan. In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.
Need help making a decision; the best advice is to contact a broker at 702.579-2250 or visit HEREThis service is provided free of charge.
