How are the Covered CA health insurance plans designed?
The principal is based on a Tier program of insurance plans. There are four tiers of insurance starting from the Bronze, Silver, Gold & Platinum with the Platinum being the most comprehensive. There are also the Minimum Coverage plans available up to 30 years which is even less comprehensive than the Bronze tiered plans.
The plans have numbers in their names to the right of the metal tier such as the Bronze 60, Silver 70, Gold 80 or Platinum 90. These numbers represent the percentage the insurer pays towards your healthcare costs such as 60% towards claims on a Bronze 60 plan or 90% coinsurance on a Platinum 90 plan. The member would be responsible for the 10-40% coinsurance not paid by the insurer.
In addition to the standard 4 plans, lower income members may also qualify for cost-share reduction Silver plans such as the Silver 73, Silver 87 & Silver 94 plans if the household adjusted gross income is within 138-250% of the Federal Povery Level. These CSR or cost-share reduction plans offer even lower member cost share versus the standard Silver 70 plans.
Many Americans will qualify for federal premium assistance to help lower their health insurance premiums depending on their modified annual gross income.