Gold plans are one of the four “metal” options established by the Affordable Care Act. These plans can make sense if you regularly need medical care. Gold plans typically have higher monthly insurance premiums than Bronze and Silver plans, however, they do have lower out-of-pocket costs when using medical services. The plan pays for 80% of your medical expenses, while you would be responsible for the remaining 20%, along with your premium.
Example: Going back to the arm surgery example above that costs $20,000, with this type of plan your insurance would pay $16,000 and you would be responsible for the remaining $4,000. This is in addition to your monthly premium.
A Gold plan could be the right choice if you:
- Would rather pay a higher monthly premium if it means you will pay less out-of-pocket when visiting the doctor, going to the emergency room, or using other health care services.
- Anticipate needing regular medical care.
- Already take or anticipate needing to regularly take prescription medication.
As with all four plans, your monthly premium could be lowered greatly if you qualify for the Premium Tax Credit. The Premium Tax Credit is like a discount that is paid for by the government and applied to your monthly insurance rate. The main factor in determining your eligibility is your annual household income. Depending on the state you live in, your income must be at or below 4x the Federal Poverty Line to qualify for the Premium Tax Credit.
Remember that the only difference among plans is the amount you pay, not the quality of health care you receive. By law, all four plans must meet the Ten Essential Health Benefits, which includes a free wellness visit and preventative care.
Keep in mind that under Obamacare, all plans have the same maximum out-of-pocket limits no matter which metal level you choose. These limits protect you financially, especially if you need a lot of medical care. For 2016, the annual limit is $6,850 for an individual, and $13,700 for a family, including deductibles. Gold plans pay for 80% percent of covered medical expenses before reaching the limit, and then 100% of all covered expenses after reaching the limit.
If you need to lower your out-of-pocket costs even further, consider a Platinum plan. If you do not think you will need much more than preventative medical care, and would like to lower your monthly premium, consider enrolling in a Silver or even Bronze plan.