A Platinum plan is a standardized health plan that covers up around 90% of members’ health care expenses, and the members pay the remaining 10% of their healthcare expenses in forms like copayments, coinsurance, and deductibles. It is one of the four categories of the health plans that are standardized into four categories like Platinum, Gold, Silver, and Bronze in the individual and small group markets. Platinum plans are quite popular in the small group market, but in the individual market, these plans are much less popular than the other metal-tier plans. This is mainly because due to high costs, and so insurers are less likely to offer platinum plans in the individual market resulting in limited availability. The health plan that people buy themselves through the health insurance exchanges, or directly from an insurer is termed as an Individual plan. Small group plans are the plans that are offered to small businesses. Small businesses are the business group having 50 or fewer employees, and in four states businesses up to 100 employees are considered small businesses.
What does a Platinum health plan offer?
Like all ACA-compliant health plan, a Platinum health plan should also offer 10 essential services that include:
- Prescription drug
- Preventive care, chronic disease management, and wellness checks
- Pediatric health care coverage should include dental, vision, and medical coverage
- Emergency health care
- Hospital stays but it often comes with out-of-pocket costs
- Lab services
- Mental health care
- Pregnancy and maternity coverage along with newborn care
- Ambulatory services
- Rehabilitative services and devices
In most of the cases, people having platinum plans need to make copay or coinsurance payment before the insurance carriers start paying it. However, certain healthcare services are completely covered without any additional cost to the patient that is known as preventive care services.
Preventive care services include:
- Wellness check-ups
- Immunizations like the flu shot
- Diagnostic screenings such as lung cancer screenings, and blood pressure checks
- Preventive medicines
- Fall prevention for Seniors
Who should have a Platinum health plan?
Among all the metal levels plans, a platinum health plan offers the highest percentage of medical costs. Therefore, individuals who often avail healthcare services may find Platinum plans to be more economical. Though the premium for Platinum plans are way too high compared to other options, these plans provide complete peace of mind to enrollees, as they know that their out-of-pocket expenses are covered. The right health plan tier is a personal decision, and it depends upon some factors. However, individuals who are finding it difficult to choose the right plan can take the help of experienced and train insurance advisor or health insurance portal.
Premiums of Platinum Plans
Individuals having platinum plans are required to pay monthly premiums to receive the coverage. Platinum plans are expensive than lower-value plans, mainly because platinum plans pay more money toward the enrollees’ health care bills. Every time individuals use their health insurance, they are required to pay cost-sharing like coinsurance, deductibles, and copays. Each platinum plan enrollees pays its 10% share differently. For instance, a platinum plan may have a high $1,000 deductible and is paired with a low 5% coinsurance, whereas another platinum plan might have a $400 deductible, and is paired with a higher coinsurance and a $10 copay for prescriptions.