The 4 Plans of the Affordable Care Act

There are 4 plans that will be offered under the Affordable Care Act.  Enrollment will begin on Tuesday, October 1 however pricing was released on Wednesday, September 25.  So this is a good time to compare pricing, especially if you’re self-employed or pay for an individual policy through Blue Cross, Aetna, etc.

The 4 plans appear to be modeled after the Health Savings Account or HSA plans available to individuals, families, or through some employers.  HSA plans have two components to them:

  • Health insurance policy
  • Savings account

The insurance policy provides medical coverage and allows for an annual physical including lab work and vaccinations.  These plans usually carry a higher deductible of $2,500 or $5,000 for individuals and $5,000, $7,500, or $10,000 for families.  Most people pay monthly premiums for the policy.

The savings account is similar to an IRA in how it’s set up.  Contributions are made into a health savings account, available through most banks.  Current IRS guidelines allow a person to contribute $3,250 to an individual plan and $6,450 to a family plan in 2013.  The maximum contribution for 2014 to an individual plan will be $3,300 and $6,550 for a family plan.  Individuals who are 55 and over may make a catch up contribution of $1,000 in each of these years, in addition to the plan maximums.  These funds go to cover plan deductibles and co-payments for medical services rendered.

The four plans, or benefit categories, available under the Affordable Care Act are Bronze, Silver, Gold, and Platinum.  The table below compares the benefit provided and the out of pocket co-pay associated with each plan.



Benefit Plan

Coverage Of Cost


Out of Pocket Co-Pay



40% up to current

HSA law limit



30% up to current

HSA law limit



20% up to current

HSA law limit



10% up to current

HSA law limit


The current HSA law limit is $5,950 for individuals and $11,900 for families.  HSA plans will still be available as an option through private insurers for people who want to keep the coverage they have.  The question I’ve not found an answer to is whether or not individuals and families who purchase one of the four plans will be able to also have a health savings account.  I expect we’ll have more detailed information in the next few days.

Each of the 4 plans includes the 10 essential benefits required of these plans including:

  • Ambulatory or outpatient care
  • Emergency room care
  • Inpatient treatment and care
  • Maternity and newborn care
  • Mental health and substance use services
  • Prescriptions drugs
  • Services and devices to help a person recover if injured or have a disability or chronic condition including physical & occupational therapy, speech language pathology, psychiatric rehabilitation, and more
  • Lab tests
  • Preventative services including counseling, screenings, and vaccines
  • Pediatric services including dental and vision care for kids

In addition to the 4 main plans, catastrophic plans will also be available for people under the age of 30 and some people with very low incomes.  These policies will require the policy holder to pay most costs until a high deductible is met and it provides some of the preventative care coverage included with the 4 plans.

Which plan fits an individual or family will be determined by a number of factors including current health status, how frequently a person expects to see a physician, and even a person’s budget.  Keep in mind that plans with lower percentages of coverage will cost less, but the policy holder will be expected to pay more out of pocket.  A plan with a higher percentage of coverage will cost more, but the policy holder will pay less out of pocket.

Next Tuesday, we’ll have more information and it will be time to compare and decide for those who do not have employer provided health insurance.  What do you think you’ll do?  Share your thoughts, plans, what you’ve found out, as well as any questions you may have with us in the comments section of this blog or on our Google + and Facebook pages.  I’d love to hear from you.

Evie Wise
Evie Wise


Evie Wise
Evie Wise

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