Key Features of an ACA Silver Plan
Key features of a Silver Plan include:
- Premium: The monthly premium for a Silver plan can vary depending on factors such as age, location, family size, and tobacco use. A Silver plan premium is higher than a Bronze plan premium, but lower than a Gold or Platinum plan premium.
- Deductible: Silver Plans usually have a moderate deductible, meaning it is higher than Bronze plans, but lower than Gold or Platinum plans. Your deductible is the amount you must pay out-of-pocket before your insurer starts to make payments for covered medical services.
- Cost-sharing: Once your plan deductible is met, you share the cost of healthcare with your insurer. The Silver plan’s cost-sharing structure means that the consumer pays 30% for the cost of care, and the insurer pays 70%.
- Cost-sharing reductions: Covered California provides cost-sharing reductions (CSRs) to eligible individuals and families with qualifying incomes who are enrolled in a Silver plan. CSRs help further reduce a member’s out-of-pocket costs associated with their deductible, copays, and coinsurance. It’s important to share again that CSRs are only available for those enrolled in Silver plans.
- Out-of-pocket maximum: The out-of-pocket maximum a consumer would be responsible to pay for healthcare each year varies depending on the specific plan and insurance company. However, under the ACA, there are annual limits on the in-network, out-of-pocket maximum for Covered California plans, including Silver plans. These limits are adjusted annually. Healthcare.gov states that for the 2024 plan year, “the out-of-pocket limit for a health plan through Covered California cannot be more than $9,450 for an individual and $18,900 for a family.”1
What’s Covered by a Silver Plan?
All metal level plans, including Silver plans, must cover essential health benefits mandated by the ACA, including:
- Ambulatory patient services (outpatient care received without being admitted to a hospital)
- Emergency services
- Hospitalization (surgery and overnight stays)
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative services and devices (used to help regain or recover mental and physical skills due to injuries, disabilities, or chronic conditions)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision for children
While all plans through Covered California provide essential health benefits, you can also select plans through your insurer that include coverage like dental and vision insurance.
In addition to the essential health benefits, some Silver plans include added enhanced benefits like $0 select prescription drugs and $0 virtual visits. The specific covered healthcare services can vary depending on the plan.
It's also important to review the specific details of the Silver plans offered in your state and by the insurers you're considering. Plans and insurers may offer access to a different network of doctors and hospitals for care.
Cost-Sharing Reductions for Silver Plans
Cost-sharing reductions (CSRs) are subsidies provided under the Affordable Care Act to help eligible individuals and families afford health insurance and further reduce their out-of-pocket costs including deductibles, copays, and coinsurance. This means that eligible individuals will pay a smaller share of the out-of-pocket costs for care, while the insurer covers a larger portion. CSRs are only available to consumers who enroll in a Silver Plan through Covered California.
To qualify for CSRs, you must meet the following criteria:
- You must have an income below 250% of the federal poverty level (may vary by state).
- You must not be eligible for Medi-Cal or Medicare.
- You must purchase your health insurance through Covered California.
When you enroll in a Silver plan and qualify for CSRs, your insurer will automatically apply the reductions to your plan. This means that your deductible, copays, and coinsurance will be lower than they would be for someone who does not qualify for CSRs.
For example, if you have a Silver plan with a $3,000 deductible and you qualify for CSRs, your actual deductible may now be $1,500. This means that you would only have to pay $1,500 out-of-pocket before your insurer starts paying for covered medical expenses.
How Much Does a Silver Health Plan Cost?
The cost of a Silver health insurance plan varies depending on several factors, including your age, location, family size, and tobacco use.
And, if you qualify, CSRs will further reduce overall costs associated with your deductible, copays, and coinsurance.
Benefits of Silver Health Insurance Plans
Choosing a Silver plan through Covered California comes with advantages. It’s important to review various factors, including affordability, coverage flexibility, and potential limitations to make an informed decision for you and your family.
Advantages of a Silver Plan:
- Available for as low as $0 per month, if you qualify for a premium tax credit2
- If eligible, cost-sharing reductions (CSRs) may make the plan more affordable than a Bronze plan by lowering out-of-pocket costs for care
- Coverage for essential health benefits
When considering a Silver plan, evaluate your and your family’s upcoming care, budget, and potential financial help eligibility for both premium tax credits and cost-sharing reductions. Comparing plan options and assessing the coverage details and costs can help you make an informed decision if a Silver plan aligns with your unique health needs.
Who Should Consider a Silver Plan?
Silver plans are often a good health plan option for people who are willing to pay a higher premium in return for more manageable out-of-pocket cost-sharing with their insurer when receiving care. Here are two situations where an individual or family may benefit from a Silver plan:
Those who need to balance their annual healthcare costs: Silver plans strike a balance between a plan’s monthly premium and out-of-pocket costs. They may make sense for people who have moderate health care needs throughout the year, and are willing to pay a higher premium than Bronze coverage in exchange for lower out-of-pocket expenses when visiting the doctor.
Those eligible for cost-sharing reductions (CSRs) based on income: Individuals and families who qualify for CSRs may find a Silver plan particularly appealing. CSRs reduce out-of-pocket costs for the member, often making a Silver plan more affordable overall than a Bronze plan. CSRs are only available with a Silver plan.