Platinum Plans

Platinum plans are one of the four "metal" health plans established by the Affordable Care Act. They are meant to help lower the out-of-pocket costs of those who need very frequent and/or major medical services.

Platinum plans tend to have the highest monthly insurance premiums of all metal plans. However, they also have the lowest out-of-pocket costs when you need medical care. Platinum plans pay for 90% of your medical expenses, meaning you are responsible for the remaining 10%. Such low out-of-pocket costs can prove to be financially beneficial for those who need a high-level of medical care.

The expensive monthly premiums can be reduced if you qualify for the Premium Tax Credit. The Premium Tax Credit is like a "discount" applied directly to your insurance rate that is paid for by the government. Your eligibility depends on the state you live and your annual household income, which should be at or below 4x the Federal Poverty Line.

Remember that the only difference among plans is the amount you pay, not the quality of health care you receive. By law, all four plans must meet the Ten Essential Health Benefits, which includes a free wellness visit and preventative care.

Does it Make Sense to Enroll in a Platinum Plan?

Only you can decide what type of plan is best for your individual or family needs. It is important to consider your current health, lifestyle, and medical risk factors. That said, it is always best to think in terms of the total cost of the plan, which is the monthly premium, plus your anticipated out-of-pocket costs when using the insurance.

A Platinum plan could be the right choice if you:

• Anticipate needing very frequent and/or major medical care.
• Foresee taking prescription medications on a frequent basis.
• Prefer paying a higher monthly premium if it means you will pay less out-of-pocket when visiting the doctor, going to the emergency room, or using other health care services.

Keep in mind that no matter which metal level you choose, under Obamacare, all plans have the same maximum out-of-pocket limits. These limits protect you financially, especially if you need a lot of medical care. For 2025, the annual limit is $8,550 for an individual, and $17,100 for a family, including deductibles. Platinum plans pays for 90% percent of covered medical expenses before reaching the limit, and then 100% of all covered expenses after reaching the limit.

If you find that the monthly premiums are too high with a Platinum plan, but still require relatively lower out-of-pocket costs, consider a Gold plan. If you think most of your medical care will be preventative, consider a Silver or even a Bronze plan.

To start comparing Platinum plans, enter your zip code or call (855) 980-0529 to speak with an agent.