ObamaCare Silver Plan Overview
The Patient Protection and Affordable Care Act, AKA ObamaCare, begins its Healthcare Exchange January 2014. All new “metal” plans* must cover the same set of ObamaCare essential benefits, states and providers may still offer additional or extended coverage. The Silver Plan is considered the standard among the plans, and the only metal plan that offers Federal Cost-Sharing Subsidies. Click here to compare Bronze Plan, Silver Plan, Gold Plan, and the Platinum Plan side-by-side.
*There is also a plan for those who are under thirty and do not qualify for subsidies: Healthcare Exchange Catastrophic coverage.
Below is the most up-to-date information available, as the federal and state governments work to fine tune the details of these plans we will update this article.
Silver Plans*
These Silver plans are specific to individual and family members. Click here to learn about how the Silver plan works for Small Business Employers and Employees with ObamaCare.
| Benefits | Silver Health Plan* |
| Deductible | $2,000 Med |
| Preventive | $0 |
| Doctor’s Office Visits | $45 |
| Specialist | $65 |
| Generic Rx | $19 |
| Brand RX | $50 *after $500 Rx deduct |
| Lab Testing | $45 |
| X-ray | $65 |
| Maternity | 20% *after deduct |
| Out-patient Surgery | 20% *after deduct |
| Hospital Stay | 20% *after deduct |
| ER Visit | $250 *after deduct |
| Urgent Care | $90 |
| Out-of-Pocket Max | $6,350/$12,700 (ind/fam) |
*California was the first to release its Healthcare Exchange overview, and much of information we know so far is based on their figures. CHART UPDATED 9/26/13. For information about specific details of the Bronze health plan in your state call 800-930-7956.
UPDATE 11/27/13: For an easy way to fill out your Affordable Care Act application go to the ObamaCare Exchange Healthapplication.com. Remember to fill it out and send it in as soon as possible to ensure the earliest enrollment date.
How Much is the Silver Premium?
Premiums depend on provider, age, state, region, and whether you qualify for a federal premium exchange subsidy. With California’s numbers being the first available their average Silver plan for a 21 year old is $191 without subsidies, but can be as low as $41 a month, and CA’s average Silver plan for a 40 year old is $226, and may go as low as $37 a month depending if you qualify for a subsidy.
Comparing Silver Plans to Other ObamaCare Plans
The Silver Plan will offer the second lowest monthly premium, however it is the only plan that allows for cost-sharing subsidies if you qualify.
The initial enrollment period for the Healthcare Exchange is from October 1, 2013 to March 31, 2014. For questions about the Silver Plan in your state please contact Medicoverage.
Comments and Questions
Click to leave a CommentComment from Jesus Mireles on November 05, 2014
Just one question.
Which is the better plan for people who had received a transplant and are taking immunosuppressive medications for life.
MEDICOVERAGE AGENT RESPONSE
Jesus,
Thank you for your question. Many people who have a serious illness consider plans with $0 deductibles such as a Gold or Platinum plan, but to find the right plan for you we suggest that call 800-930-7956 to speak with an agent.
-Jacima from www.medicoverage.com
Comment from jennifer on July 23, 2014
My parents have been waiting 4 months for their Blue Cross Silver plan booklet. They need this ASAP. What is the hold up??? Where can I get a copy for them immediately?
MEDICOVERAGE AGENT RESPONSE
Jennifer,
We know how frustrating waiting for their booklet can be. The new plans are taking longer to send out materials than planned. Call Blue Cross directly they should be able to mail one out to you. Also you may want to check online as providers are starting to offer digital access to benefit information.
-Michelle from www.medicoverage.com
Comment from Drew on February 20, 2014
This is not cheaper than anything and people who think so are in need of mental evaluations.
Comment from Bob R. on December 15, 2013
I keep asking the question, "what is considered Preventive Care?" I get no answers. Proponents of these plans say that preventive care is covered. What does that mean? What will a colonoscopy cost me? Does the deductible apply? It sounds like smoke and mirrors to me. Just because something is "covered" doesn't mean that you won't have to pay. If you couldn't afford insurance to begin with, you won't be able to afford "preventive" tests if you have to pay the premiums plus the out of pocket expense.
MEDICOVERAGE AGENT RESPONSE
Bob,
Thank you for your follow up question. The simple answer is that there is no cost for preventive as long as it falls under the Federal Guidelines for Preventive Services. Here is a quick snapshot from the CMS:
All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.
Abdominal Aortic Aneurysm
Alcohol Misuse screening and counseling
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Diabetes (Type 2) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for everyone ages 15 to 65,
Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling
Syphilis screening for all adults at higher risk
Tobacco Use cessation interventions for tobacco users
Hope that helps,
-Chris from Medicoverage
Comment from Steven Eddy on December 11, 2013
I live in north Carolina, I am looking at the silver plan, however, I am not sure what plan to go with, I am in need of a kidney biopsy, and probably more care for the kidneys over time,, which plan would be good for someone like me?,, thanks for any advice you can offer!!,, Steve Eddy
MEDICOVERAGE AGENT RESPONSE
Steve,
Thank you for your question. Silver tends to be our most popular plan but if you know you have an upcoming procedure, it may make sense to consider a more expensive plan with less cost sharing. Additionally you will want to pick a plan that has your doctors in the network. Due to your specific question, please call 800-930-7956.
-Kelly at www.medicoverage.com
Comment from Bob R. on December 06, 2013
What exactly does "prevention" include? For instance can I get a colonoscopy without incurring any expense out of pocket? What is "preventive?"
MEDICOVERAGE AGENT RESPONSE
Bob,
Thank you for your follow up questions. Preventive care is to to help you before you get sick, these services are $0 if they are offered by an in-network doctor. An example of these services are vaccinations, mammograms, and colorectal cancer screenings (for people 50 and over). If you want to discuss the comprehensive list of preventive services, give us a call.
Eric at www.medicoverage.com
Comment from Bob R. on November 30, 2013
Do I understand that right? It pays 20% of a hospital stay? When they say "out of pocket maximum" does that mean a hospital stay will be paid at 100% after the out of pocket max is met?
MEDICOVERAGE AGENT RESPONSE
Bob,
Thank you for your questions. Once you have met your out of pocket max, your plan will pay 100% of your hospital stay, as long as you stay in network.
As for hospital stays for a plan with 20% coinsurance, you (the patient) would pay 20% of hospital costs AFTER your deductible is satisfied.
Remember: this chart only represents California's cost breakdown, and your plan may vary significantly from this chart. To learn your specific out of pocket costs call 800-930-7956.
-Michelle at Medicoverage.com
Comment from Jay on November 27, 2013
Ok, so my premium will cost me almost $1000 per month with a deductible of $12,500. So if at the end of the year something happens to me or someone in my family it will cost me almost $25,000 plus 30% of anything over the $12500. How on earth is this affordable? The ACA was supposed to be passed to keep people from filing BK because of healthcare costs. I'm here to tell you, if I get a bill for $25000 I'm filing BK because I can't afford that! Plus, if I do need some sort of surgery the Dr isn't going to to it until I pay him the $12,500, and that ain't gonna happen so I'll end up going without health care anyway!!
Comment from Barbara Nieland on November 04, 2013
I've paid $540 a month for $3000 deductible insurance for the past four years and Assurance Health doesn't pay a dime till you meet your deductible. Silver plan sounds good to me.
Comment from Tom Loyd on October 15, 2013
The preventive is great but the deductibles and when they apply plus the co-pays, out of pocket and premiums combined will be to much for millions of people.
If it turns out that people buy a plan and can't afford all the co-pays, will they be kicked off Obamacare?
MEDICOVERAGE AGENT RESPONSE
Tom,
Good question. Copays are paid at the time of service, so that would be your doctor that may turn you down. But to answer your question if you'll be kicked off a plan, probably not. Your medical billing may be sent to collections, as it is billed by your doctor.
Now, if you don't pay your premium, yes, you could be kicked off a plan. But this is true for plans now. If you have an individual plan, you can keep your plan for up to 3 months without premium payment. And your doctor could end up paying out of pocket for your services, if you don't pay your ACA premium.
For further questions about the plans call 800-930-7956.
-Eric at Medicoverage.com
Comment from Carol Cleary on October 14, 2013
Gee Shane, Renee, and Joe - sounds like you are wanting something for nothing. My company provided insurance is a 70-30 and guess what? I pay a WHOLE LOT MORE for it!
Comment from shane on October 02, 2013
this plan covers some stuff,but my plan cosy is 114.00 a month,2500 deductible.and after the deductible they pay 100 percent.silver sucks.but have at it
Comment from renee on October 02, 2013
Wow not impressed
Comment from Marco B. on September 27, 2013
Silver Plans are the bomb. a $2000 deductible is kinda high (although many people with indivdual coverage have higher deducts) but you don't have to pay the deductible for doctor visits, x-rays, lab work and it covers brand name drugs.
You really only have to pay the deduct unless you end up in the hospital.
This is the plan I'm signing up for if it is affordable. Just waiting for my state to get their act together so I can get a true quote. Not averages.
Comment from Joe on September 14, 2013
Wow. The more I look at the plans and the amounts I will pay and the very little amount the insurance covers-the worse it looks.