ObamaCare – Expansion to 138% of FPL
ObamaCare – Expansion to 138% of FPL

What is an Enhanced Silver-level Plan?

If you qualify for cost-sharing subsidies, you will get the out-of-pocket savings that may increase the ‘value’ of a Silver-level plan to that of a Gold or Platinum plan, yet at a Silver-plan price.

Please note that the FPL Federal Poverty Level, premiums & benefits change every year.  The BEST way to see what you qualify for is to get a complementary quotation.

What is Silver Loading? 

Why is it less $$ to buy a Silver Plan direct from an Insurance Company rather than Covered CA if you don’t qualify for subsidies?

Note that there is no extra charge to use an agent, either way.

In Covered California all plans offer the same standard benefits. The platinum plans offer those same benefits with cheaper out-of-pocket costs (e.g. co-pays and co-insurance), but with higher premiums. For a Platinum-level plan, on average over the period of a single plan year, the health plan will cover 90% of the out-of-pocket costs on behalf of an individual (also known as a 90 actuarial value). For instance, a primary care visit in a Platinum-level plan is $20.

The typical Silver-level plan, however, offers the same benefits with higher out-of-pocket costs and lower premiums. For a Silver-level plan, on average over the period of a single plan year, the health plan will cover 70% of the out-of-pocket costs on behalf of an individual (also known as a 70 actuarial value). For instance, a primary care visit in a Silver-level plan is $45.

When you receive the cost-sharing subsidies, the value of the Silver plan can increase to become better than a Platinum or Gold-level plan, depending on your income. Below is a description and chart of the Enhanced Silver-level plans:

Enhanced Silver 94: If you have an income between $15,857

($11,490 if not eligible for full-scope Medi-Cal  *  See our pages  on  Share of Cost * Medi-Cal Expansion *   This does NOT apply in CA.  

 

$17,235, you would qualify for an Enhanced Silver-level plan 94, which has a 94 actuarial value. This means that on average over the period of a single plan year, the health plan will cover 94% of the out-of-pocket costs on behalf of an individual, lowering the cost of a primary care visit from $45 (typical Silver-level plan) to only $3 ($17 cheaper than the typical Platinum-level plan). Platinum plans have an actuarial value of 90 (a value of 4% less than an Enhanced Silver 94 plan).

 

Enhanced Silver 87: If you have an income between $17,236 and $22,980, you would qualify for an Enhanced Silver-level plan 87, which has an 87 actuarial value. This means that on average over the period of a single plan year, the health plan will cover 87% of the out-of-pocket costs on behalf of an individual, lowering the cost of a primary care visit from $45 (typical Silver-level plan) to only $15 ($5 cheaper than a Platinum plan and $15 cheaper than a Gold plan). Gold plans have an actuarial value of 80 (a value of 7% less than an Enhanced Silver 87 plan).

 

Enhanced Silver 73: If you have an income between $22,981 and $28,725, you would qualify for an Enhanced Silver-level plan 73, which has a 73 actuarial value. This means that on average over the period of a single plan year, the health plan will cover 73% of the out-of-pocket costs on behalf of an individual. Lowering the cost of a primary care visit from $45 (typical Silver-level plan) to only $40 ($5 cheaper than a Silver plan). Silver plans have an actuarial value of 70 (a value of 3% less than an Enhanced Silver 73 plan). coveredca.com/#118

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