Gold Healthcare Exchange Plan Outline of Coverage
What Is the Gold Plan?
The Gold plan is one the Affordable Care Act, AKA ObamaCare, plans. The four plans ranked from least expensive monthly premium to most: Bronze, Silver, Gold, and Platinum*. All plans will all offer the same essential benefits, however additional/extended benefits may be offered by different insurance providers. Gold is one of the plans that must be offered by your insurance provider if they choose to offer any of the plans, the other is Silver. Gold offers comprehensive coverage with predictable out-of-pocket expenses (combination of deductible, copayment, and coinsurance).
*There is also catastrophic coverage, if you qualify.
Gold Plan Overview
The following information below is for individual and family members. Click here to learn about how the Gold plan works for Small Business owners.
- 80/20 split, with you paying 20% for healthcare expenses
- 2nd highest monthly premium. This is without federal subsidies, Do I Qualify for Federal Subsidies?
- Either no or a low deductible
| Benefits | Gold Health Plan* |
| Deductible | $0 |
| Preventive | $0 |
| Doctor’s Office Visits | $35 |
| Specialist | $55 |
| Generic Rx | $15 |
| Brand RX (Tier 2) | $50 |
| Lab Testing | $35 |
| X-ray | $50 |
| Maternity | $600 per day HMO**/20% PPO |
| Out-patient Surgery | $600 HMO/20% PPO |
| Hospital Stay | $600 per day HMO**/20% PPO |
| ER Visit | $250 |
| Urgent Care | $60 |
| Out-of-Pocket Max | $6,200/$12,400 (ind/fam) |
**Up to 5 days in the hospital
*The chart above is for California. To learn what insurers cover in your state get a Healthcare Exchange quote.
Is there only one Gold Plan offered?
There may be multiple plans within states. Specific plans will be determined by state leaders and insurance providers.
How Does the Gold Health Plan Compare to the Other New Plans?
Gold will have the 2nd highest monthly premiums, but Gold plan members, due to the 20% co-share, will have lower cost-sharing expenses than a plan with a lower monthly premium. Click here to compare Bronze, Silver, Gold and Platinum health plans side-by-side.
Over 65 and ObamaCare
For seniors over 65, ObamaCare does not work the same. Click here to learn more about the Health Care Exchange and Senior Options.
For any questions or assistance in applying during the open enrollment period, please contact Medicoverage. If you’re ready to apply click here to get a Healthcare Exchange application.
Comments and Questions
Click to leave a CommentComment from Robert Slogar on February 13, 2016
What would a gold plan cost me on average in the state of Missouri if I qualified for 100% of the subsidies?
MEDICOVERAGE AGENT RESPONSE
Robert,
Subsidies and plan pricing depends on your DOB, zip code, and if you use tobacco (in some states). You can get a Missouri Gold plan quote without subsidies. To learn what you would qualify with subsidies, call 800-930-7956.
-Eric from http://www.medicoverage.com/
Comment from Cheri on October 26, 2015
If I need surgery does this plan give me the coverage for surgery also.
MEDICOVERAGE AGENT RESPONSE
Cheri,
All the new ACA (aka Obamacare) plans offer coverage for surgery. Remember that each provider and state may lay out their coverage differently, though. Please contact us if you need help finding a plan -800-930-7956.
-Chris from http://www.medicoverage.com/
Comment from Kenneth Peele on August 09, 2015
Im currently looking for affordable insurance coverage since my job has been bought out and I refuse the package deal that they now offer. I work with a Optum rx Mail service as a Subject Matter expert supervisor. We handle processing for UHC. Im not use to seeing a monthly deductable on plans. What is the monthly deductable price on each plan you offer and what does that cover? I would need to know how much im paying for coverage monthly total, under the most affordable plan that can be offered.
MEDICOVERAGE AGENT RESPONSE
Kenneth,
We understand your confusion. The premium is monthly (the amount you pay directly to the pay the plan), and the deductible is annual. The deductible is the amount you pay toward all or certain services before your plan pays toward services. We say certain, because some companies waive the deductible for services such as doctors’ office visits and lab work. We suggest you call us at 800-930-7956 so that we can look up the most affordable plan in your area.
-Amy from http://www.medicoverage.com/