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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.
Although Gold plans have fairly higher premiums, as with all metal plans your monthly insurance rate can be reduced 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 directly to your monthly rate. Your eligibility depends on the state you live and your annual household income, which should be at or below 4x the Federal Poverty Line.
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.
Does it Make Sense to Enroll in a Gold Plan?
Only you can decide what type of plan is best for your individual or family needs. It is important to consider your current health, lifestyle, and medical risk factors. That said, it is always best to think in terms of the total cost of the plan, which is the monthly premium, plus your anticipated out-of-pocket costs when using the insurance.
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;
Keep in mind that no matter which metal level you choose, under Obamacare, all plans have the same maximum out-of-pocket limits. 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 pays 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 rate, consider enrolling in a Silver or even Bronze plan.
To start comparing Gold plans, enter your zip code or call (877) 935-9291 to speak with an agent.