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.

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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