Welcome To The Bitchery

ETA: I called the Marketplace directly and they explained everything to me! Which I will now share with you very helpful people.


So for people who qualify financially, the ACA is set up so that depending on your level of need, they will guarantee that no more than a certain percentage of your medical costs come out of your pocket. If you're a level 4, this is 27%, if you're a level 5 its 13%. If you're a level 6, it's 6%. They will adjust your co-pays, deductibles, out of pocket maximums accordingly.


This however ONLY applies to Silver plans - no other plans are eligible for these savings. This is why I was seeing that I was actually getting cheaper coverage and better coverage at a lower plan. For instance, if you notice below in the screenshot, you can tell my friend is a level 6 because the Silver plan notes that they'll cover 94% of all medical care (more than a Gold or a Platinum). When I went in and did a side by side comparison of the same plan from a provider at Gold versus Silver level, it was really obvious (and the Silver plan does have a "Reduced Costs" notation on it)

So, I am not crazy, and the system is set up so that my friend can have super cheap and good health care! (I'm actually pretty jealous now, they have better insurance than I do through work).


So I'm covered through work, but as a Christmas present to a friend who has ADD and anxiety I offered to dig through all of the millions of plans of ACA and help them sign up. So far, it's been super easy - the website has been great and easy to use, and the plans are all laid out and you can check them out.


But where I'm getting confused is that from what I can see, the Silver Plans are actually better deals for the most part than the Gold plans? Am I crazy? It seemed like it when I was browsing, but when the site gave me the actual summary to start purchasing below it seems like a no brainer to pick a Silver plan. Am I missing something important here??


Lower average copay, lower out of pocket maximum, covers 94% instead of 80%, lower premiums?

If it helps, this is a person that does need to see doctors fairly regularly - low copays are really good, and good coinsurance is important because there are good chances they will need to have things done, and they see even a chiropractor at least a few times a month.


Help me Hivemind!!!!

Share This Story

Get our newsletter