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Platinum level: On average, the health plan pays 90% of covered health-care costs; the consumer pays 10%. Minimum coverage plan (worst-case scenario) : If the consumer is under 30 and cannot afford the other plans, this is another option.
Within the exchanges, insurance plans are offered in four tiers designated from lowest premium to highest premium: bronze, silver, gold, and platinum. The plans cover ranges from 60% to 90% of bills in increments of 10% for each plan.
[26] [44] The percentages of health care costs that plans are expected to cover through premiums (as opposed to out-of-pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum). [45] Insurers are required to implement an appeals process for coverage determination and claims on all new plans. [37]
As of 2015, about 14.1 million people were insured privately, including in self-funded plans; 1.3 million were in plans regulated by the CDI and 12.7 million were in plans regulated by the DHMC. [9] Kaiser Permanente had about 50% of the market, followed by Blue Shield of California, Anthem Blue Cross, and Health Net (a subsidiary of Centene). [9]
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