Choosing a Health Insurance for Your Business
There are four categories of plans in the SHOP Marketplace. They all offer similar benefits. This difference is on how your employees and the plan share the costs of care.
In all states, you can offer one plan to your employees. In some states, you can choose a category and let your employees choose any plan in that category. Learn more about Employee Choice.
SHOP health plan categories: Bronze, Silver, Gold, Platinum
The category you choose affects how much your employees pay for such things as premiums, deductibles and copayments, and their out-of-pocket costs for the year if they need a lot of care.
- Bronze: The health plan covers about 60% of the total costs of care. The employee pays about 40%.
- Silver: The health plan covers about 70% of the total costs of care. The employee pays about 30%.
- Gold: The health plan covers about 80% of the total costs of care. The employee pays about 20%.
- Platinum: The health plan covers about 90% of the total costs of care. The employee pays about 10%.
Choosing a plan that works for you
A plan’s category has nothing to do with the quality of care it provides. All plans offered through the SHOP Marketplace must provide a set of essential health benefits. Plus, they all cover pre-existing conditions
When you offer SHOP coverage you and your employees each pay part of a monthly premium. Just as important as the monthly premium is how much your employees have to pay out of pocket when they get care. The plan with the lowest premium may not provide you or your employees with the best overall value.
Balancing premiums and out-of-pocket costs
- Premiums are usually lower for plans that pay a smaller share of medical costs when your employees get care. For example, with a Bronze plan, your employees will probably pay a lower monthly premium than they would for a Gold plan. But they'll probably pay more when they use medical services.
Platinum plans generally have the highest monthly premiums and lowest out-of-pocket costs for services. They will likely provide better financial protection if your employees use a lot of services or have a health crisis.
Keep this in mind: The lower the premium, the higher the out-of-pocket costs. The higher the premium, the lower the out-of-pocket costs.
Give us a call so to discuss your options and what makes sense for you and your employees.
For more information visit www.healthcare.gov