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What does the silver plan under obamacare cover?

Here's what you need to know...
  • The Obamacare Silver Plan qualifies for tax subsidies based on income
  • The Obamacare Silver Plan qualifies for payment assistance based on income
  • Some silver plans are Obamacare benchmarks for determining subsidies
  • Silver Plans have an actuarial value of about 70 percent.

The Silver Plan balances coverage in a favorable way for consumers. These plans offer a range of variety in deductibles and out of pocket expenses. They also reflect the range of service provider models and network resources. When considering Silver plans, many consumers use other aspects of the Affordable Care Act such as the use of Health Savings Accounts to cover deductibles and out of pocket expenses. Comparison shopping is the best way to assess the strengths and advantages of an Obamacare health plan. Comparison shopping focuses the effort on the points of importance to the individual or family applicant. Start comparing health insurance rates now by using our FREE tool above!

The Ten Essential Benefits

Every qualified health plan contains the ten essential health benefits required by the ACA and at no extra cost to the consumer. These include annual physical exams, lab work, screenings, and preventive care.

The Types of Plans

Obamacare ranks plans according actuarial value or the amount of insurance payment for essential benefits compared to consumer payments. The similarity of plans with the same label may not appear on the surface, but in terms of coverage percentage, there are firm similarities among the metal bands. The below listed items describe the four types of plans.

  • Platinum plans have an AV of ninety percent, high premiums, low deductibles, and low out of pocket costs.
  • Gold plans have an AV of eighty percent or more, high premiums, and lower deductibles and out of pocket costs than Silver and Bronze.
  • Silver plans have an average AV of 70 percent, moderately high premiums and a range of deductibles from high to moderate. Some silver plans mix well with health savings accounts.
  • Bronze have an AV of sixty percent or more. They have low premiums and higher deductibles and high out of pocket costs.
  • Catastrophic plans are only available to limited numbers of under-30-year-old applicants. The usual path to a catastrophic plan involves hardship exemptions.

Silver Benchmark Plans

The second lowest priced Silver Plan is the benchmark plan used to determine the cost assistance levels for each state. Using the federal poverty level, the second lowest silver plan sets the exact point for capping benefits in the State at 9.5 percent. Higher plans would get less, and lower plans would get more subsidies.

Actuarial Value

The actuarial value or AV is a figure that describes the percentage pf the ten essential benefits in the plan will be paid by insurance rather than the consumer.

A Silver plan has an average AV of 70 percent.

This means that is an estimated average; the plan would pay seventy percent of costs and the consumer would pay thirty percent.

Silver Plan Subsidies

The silver plans qualify for cost-sharing reduction subsidies by raising the actuarial value of the silver plan; the cost-sharing subsidies lower the amount consumers must pay out of pocket for plan expenses. Expenses include deductibles, coinsurance, and co-payments. The Cost-Sharing Reduction subsidy applies to benefits covered in the silver plan and not to services outside of the particular plan.

Health Savings Accounts and Silver Plans

Pairing a Health Savings Account ( HSA) with a Silver plan is a successful combination for many consumers. Using an HSA to cover unexpected medical expenses permits selection of a high deductible Silver Plan. In some cases, the use of an HSA can reduce the family or individual income figure and increase the amount of tax subsidy. The combination of Silver and HSA can reduce monthly premiums, increase the value of the insurance coverage, and provide a valuable asset either for paying expenses in the instant year or future years.

Out of Pocket Costs

All Obamacare marketplace plans have a maximum out of pocket costs limit. In 2015, the maximum out of pocket costs were set at $6,600 for an individual and the maximum for a family was $13,200. The plans must provide at least ten of the essential benefits in their covered benefits package. Premiums do not count as out of pocket expenses nor do costs for non-essential health benefits.

Open Enrollment

Consumers can only buy silver plans during Open Enrollment or a special enrollment period that arises from a Life Event. Consumers must purchase Silver Plans through the Obamacare Marketplace to get tax subsidies and payment assistance.

Many shoppers use private insurance agents to develop recommendations for getting the best coverage and using assets.

This is a wise course. However, to qualify for benefits, the purchase of insurance plans must be through the Obamacare Marketplace.

Silver Plans Cover Important Risks

Silver plans can cover the risks that are most important to particular individual or family applicants. Because they qualify for payment and premium subsidies, they offer high value to consumers. Within the band of plans labeled as Silver Plans, there is a wide variety of coverage, costs, and deductibles. There are also differences in the usage of provider resources such as co-insurance for resources outside of the provider’s network. When combined with Health Savings Accounts, Silver plans use the power of saving to cover risks and build financial strength. Start comparing health insurance providers and rates now by entering your zip code in our FREE tool below! Comparison shopping brings a sharp focus on the needs of the consumer for the price, value, and particular services and locations. It is the best way to select plans on or outside the Obamacare Marketplace.

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