What Is Platinum Health Insurance?
Platinum health insurance has high monthly rates, but it will pay for about 90% of your costs when you visit the doctor.
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A Platinum health plan is the best fit for you if you have serious or ongoing health problems. Expensive monthly rates mean you'll usually have a low deductible, out-of-pocket maximum, copays and coinsurance.
But, a Platinum plan probably won’t make good financial sense if you’re young or in good health.
What is Platinum health insurance?
Platinum health insurance is the most expensive of the four plan tiers you can buy on HealthCare.gov or your state marketplace.
Platinum health insurance has high monthly rates, but also cheap costs you're responsible for paying when you go to the hospital or get a prescription filled. That almost means lower a copays and coinsurance. Platinum plans also have a low cap on how much you'll pay at the hospital per year, called an out-of-pocket maximum.
That makes Platinum health insurance a good choice for people who expect to need a lot of medical care in the coming year. However, if you're in good health, a Platinum plan would probably be a waste of money. That's because you won't get better care with Platinum coverage.
Health insurance plan tiers only impact how your medical bills are split between you and your insurance company. Platinum plans are designed so your insurance company covers about 90% of your medical costs, and you pay off the remaining costs. However, you may pay more or less than that 10% figure since it’s an average cost that is not specific to your personal situation.
Cost sharing by plan tier
Plan type | Insurance pays | You pay |
|---|---|---|
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
It’s important to remember that your monthly rate doesn’t cover medical care like doctor appointments or hospital bills. Your rate only pays for the insurance policy. Generally speaking, the higher your monthly rate, the less you'll pay when you go to the doctor.
Where is Platinum health insurance available?
You can buy a Platinum plan through your state’s health marketplace or directly through an insurance company. However, not all top health insurance companies offer Platinum plans. Of those that do, many companies only sell Platinum health insurance in certain parts of the country.
Only 19 states and Washington, D.C. have options for Platinum coverage through their health exchanges.
- California
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Indiana
- Massachusetts
- Maryland
- Maine
- New York
- Pennsylvania
- Rhode Island
- Tennessee
- Utah
- Virginia
- Vermont
- Washington D.C.
- Wisconsin
- West Virginia
Platinum plans may not be available everywhere in the states where they're offered. That means you may have to switch to a lower plan tier if you move to a new area.
What does Platinum health insurance cover?
The Affordable Care Act (ACA) requires most health insurance plans to cover 10 essential services like preventive services and mental health care regardless of plan tier. You can get the same type of coverage from a Bronze, Silver, Gold or Platinum plan.
You can also personalize your Platinum plan by buyingsupplemental insurance, which can help pay for some of the leftover costs you have to pay with Platinum health coverage.
Is Platinum health insurance right for you?
You won’t get as much benefit from Platinum health insurance unless you expect to need expensive medical care in the coming year.
Most people who are young or healthy would be better off with a cheaper insurance option. That’s because the average person doesn’t have high enough medical costs for the more expensive monthly rates to make sense.
Good for
If you expect to hit your out-of-pocket maximum for the year, a Platinum insurance plan might make sense. However, you’d still have to run the numbers to make sure the Platinum plan’s higher monthly costs don’t erase your savings.
Average health insurance cost by plan type
Plan tier | Monthly rate (national average) |
|---|---|
| Bronze | $488 |
| Silver | $621 |
| Gold | $676 |
| Platinum | $913 |
All figures are for a 40-year-old who doesn't qualify for rate subsidies, also called premium tax credits.
The cost of a Platinum plan can differ dramatically depending on where you live. For example, the average cost of a Platinum plan in Maryland is just $470 per month. The same coverage in West Virginia costs $1,946 per month, on average.
Nearly everyone who has marketplace health insurance qualifies for discounted coverage, called subsidies or premium tax credits, even with higher tier plans.
Subsidies can lower the amount you pay for health insurance by hundreds of dollars per month. You can get ACA subsidies for Platinum plans if you earn up to about $63,000 per year for a single person (roughly $129,000 per year for a family of four).
You may also qualify for subsidies if you pay more than 8.5% of your income on health insurance, regardless of how much you make up through the end of 2025, when this rule will end.
Frequently asked questions
What is Platinum health insurance?
Platinum health insurance is the most expensive level of health care coverage you can get. The upside is that you pay very little when you go to the doctor. Plans typically have a small or zero dollar deductible and cheap copays and coinsurance.
Is Platinum health insurance worth it?
Platinum health coverage might make sense if you need a lot of medical care. But, if you don’t have significant, ongoing health issues, you’ll likely be better off with a less expensive type of health insurance.
How much does Platinum health insurance cost per month?
Platinum health insurance costs $913 per month, on average. The amount you pay will depend on where you live and the size of your subsidy if you earn less than $63,000 per year ($129,000 for a family of four).
Methodology
Information about Platinum health insurance is from HealthCare.gov. Average rate data was taken from Centers for Medicare & Medicaid Services (CMS). Other sources include the Kaiser Family Foundation (KFF) and the Department of Health and Human Services (HHS). Rates are for a 40-year-old non-smoker.
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