09 Nov 2015

What we love/hate in 2016… about Platinum plans

09 Nov 2015

This is part of a series of posts to help clients understand the differences between the carriers and plans, and to make the best plan choice for their family in 2016. Maybe “like” and “dislike” are better categories, but what is the Internet for, if not strong opinions?

“Platinum” level PPO and HMO plans certainly sound like the top tier options, and they are. But do these plans make financial sense? There is no difference in the number or quality of providers you get when you buy a Platinum plan from a carrier vs. their Gold, Silver or Bronze option using the same network. And there isn’t an added set of covered benefits/medical conditions. So who is buying Platinum plans in 2016?

Love

  • This one is past tense, but we loved Assurant Health’s Platinum plans in 2015. One plan had a $950 out of pocket maximum for the year, which was valuable for several clients with expected high usage. Editors note: we feel pretty confident this is what put Assurant out of the health insurance business.
  • Platinum plans for child-only coverage. The difference in premium between Bronze and Platinum for a child alone on a policy, is far more moderate than for an adult. A child under age 18 with expected high usage of medical/Rx services may be a great fit for a Platinum plan.
  • Platinum plans for adults, but for a partial year only. How can you buy Platinum for a partial year? A pregnant mother expecting delivery early in 2016 is one example. She could then use the qualifying event of the birth to switch plans midyear. Or someone who loses employer coverage in October and expects high medical/Rx usage for the last couple of months of the year.

Hate

  • Platinum plans for everyone else. The high premiums simply do not make financial sense, with a very small handful of exceptions. Let’s use an age 37, single San Francisco woman as an example. The average difference between buying a low-cost Bronze plan (annual max out of pocket: $6,500) and a pricey Platinum plan (annual max out of pocket: $4,000) is almost $500 per month or $6,000 for the year. That means with a high level of medical/Rx usage, an individual could wind up paying close to $4,000 more on the Platinum plan vs. Bronze (total premium + total out pocket costs).

Still not sure, or have questions about Platinum plans? Let us know by contacting us, or if you want to disagree, feel free to post in the comments section below.

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