You only need to know five terms – Platinum, Gold, Silver, Bronze, & HSA

Every insurance company offers one or more plans within each of the Platinum, Gold, Silver and Bronze categories. Below are a few of the most popular offerings and can serve as “model” plans. The first four plans are traditional plans. The fifth is a Consumer Directed Health Plan. Insurance companies will use terms like “HSA,” or “Savings” to indicate these plans.

Platinum 0 Highest cost plan with zero deductible and very low copays
Gold 750 Higher cost plan with lower deductible and low copays
Silver 1300 Lower cost plan with moderate deductible and copays for office visits and RX
Bronze 5000 Low cost plan with high deductible, three office visit copays AND copays for RX drugs
Bronze HSA 5000 Lowest cost plan. Qualifies for HSA because there is a high deductible and there are no copays for office visits or prescriptions. Plan member uses Health Savings Account (HSA) to pay routine and expected expenses while also being able to save for future deductibles.

Category

Platinum 0

Gold 750

Silver 1300

Bronze 5000

Bronze HSA

The 3 Elements

Deductible $0 $750 $1,300 $5,000 $5,000
Coinsurance 10% 20% 30% 40% 40%
OOP Max $4,000 $5,500 $6,800 $6,800 $6,500

Office visits

Preventive $0 $0 $0 $0 $0
Primary Care $10 $20 $45 $60 Negotiated Fee

Apply to deductible

Labs, imaging 10%>ded 20%>ded 30%>ded 40%>ded 40%>deductible
Hospital/surgery
outpatient surgery
10%>ded 20%>ded 30%>ded 40%>ded 40%>deductible

Prescription Drugs

Generic RX $5 $10 $15 $15 40%>deductible
Brand RX Formulary $30 $30 $55 $50 40%>deductible
Brand RX Non-Form $50 $60 $75 $75 40%>deductible