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Understanding the Gold Plan
Among the four new categories of health insurance plans created by the Affordable Care Act (ACA) is the Gold Plan. The Gold Plan offers the second lowest out-of-pocket costs of the new plan types. Only the Platinum Plan offers lower out-of-pocket costs for a standard enrollee population. The Gold Plan provides the same essential benefits as the other plan types. Essential benefits are the minimum services to be covered by an Affordable Care Act health insurance plan. However, individual plans do have the option of enhancing their benefits beyond the basic benefits required by the ACA.
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Gold Plans are required to cover 80% of the medical costs with the remaining 20% paid by the plan enrollee. The 80% figure is based on the government’s expectation of healthcare usage. Depending on what services you use, this coverage may not exactly match 80% of medical costs. The 20% of healthcare costs paid by the enrollee would be in the form of out-of-pocket deductibles, copayments, and coinsurance fees. The monthly premium for the Gold Plan, however, is paid for in addition to the out-of-pocket costs mentioned earlier.
The Gold Plan is one of the two plan types along with the silver plan that an insurance company must offer in order to participate in a health insurance exchange. A health insurance exchange is a state marketplace for health insurance plans meeting the ACA requirements.
Out-of-Pocket Costs for Gold Plan Enrollees
Based on an average person’s expected use of healthcare services, Gold Plans have the insurance company pay 80% of covered healthcare expenses. The remaining 20% of expenses are paid out of pocket by the policyholder. These out-of-pocket expenses include deductibles, copayments, and coinsurance. However, the plan’s monthly premium is not included as one of these out-of-pocket costs.
Gold Plan Premiums
Gold plans have the second highest premium rates of the four new types of metal plans since they charge the second lowest out-of-pocket costs. However, there may be instances where the Gold Plan for one insurance company may charge a lower premium than the Bronze or Silver Plan of another insurance company, as well as instances where the Platinum Plan for one insurance company may charge a lower premium than the Gold Plan of another insurance company. Comparing plans is essential for anyone trying to minimize their healthcare expenses.
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