The Olympics are going on! Olympic athletes will tell you that not only is it important to be in good shape and fine tune your athletic skills, it is also important to know the rules of engagement. For instance, in gymnastics, what will give you a small points deduction, and what will give you a large deduction? What if you have a false start in swimming or track?
In the Olympics, Go for the Gold!
And while in preparation for the Olympics, athletes may be trained to "Go for Gold," understanding the rules of engagement for health care coverage may lead you to a surprising conclusion:
In Health Care, Go for the Silver! (Maybe)
The advice that you "go for the silver" might be surprising to you, considering that health care plans are ranked as Bronze (covers 60% of health care costs); Silver (70%); Gold (80%) and Platinum (90%). Surely gold and platinum plans, then, are better bets than silver or bronze plans?
That might be true if you are a mere mortal, and not a true Olympian.
But if your income is below 250% of the poverty level ($29,700 for a single person, or $60,750 for a family of four), then the rules of engagement change, and you get a special Super Power! (And no, it's not steroids, and it won't disqualify you from the Olympics or from health care coverage.)
If your income is below 250% of the poverty level, then you qualify for special cost-sharing, and the silver plans will cover more than their usual 70% of the cost of the health care. In this case, by choosing a silver plan you will get lower co-pays, deductibles, and maximum out of pocket costs.
If your income is below 150% of the poverty level ($17,820 for a single person, $36,450 for a family of four), the silver plans will cover 94% of the costs, even better than a platinum plan!
If your income is between 151% and 200% of the poverty level ($23,760 for a single person, $48,600 for a family of four), the silver plans will cover 87% of the costs, even better than a gold plan!
If your income is between 201% and 250% of the poverty level (maximum $29,700 for a single person, and $60,750 for a family of four), the silver plans will cover 73% of the costs, better than a regular silver plan. [However, at this point the cost sharing is not better than a gold plan, and if you have a lot of health needs you may be better off choosing a gold plan. You will pay a higher premium but you will get more coverage.]
If you are curious about particular plans and how much they would cost for you, take a look at these estimating tools:
Marketplace Estimator healthcare.gov/see-plans
Prepare, Predict, Go for it!
So--just like an Olympic athlete, you can:
Prepare: Understand how to calculate your family size and your household income is (here's how to do that);
Predict: Whether a silver plan will offer special cost-sharing benefits for you;
Go for it: During Open Enrollment or a Special Enrollment period, fill out your application and choose the best health plan for yourself and your family!
Open enrollment begins November 1, 2016 and ends January 31, 2017.