La Opinión — People who sign up, whether in the state insurance marketplace or through the federal exchange (Obamacare), will have to choose one of four tiers of medical coverage: bronze, silver, gold, and platinum.
The decision can be complicated since the person must try to figure out — or even guess — how much coverage he or she needs, explained Erin Trish, post-doctoral fellow at the Center for Health Policy and Economics at the University of Southern California (USC).
The bronze plan could be the most attractive tier because the monthly premiums are the least expensive, but the person will have to pay more each time he or she requires medical services. This tier pays for 60% of medical expenses. The silver tier pays for 70%, the gold for 80%, and the platinum for 90%.
Trish explained that "the difference between the tiers is calculated based on actuarial values. " Basically, this means that for more coverage, the monthly premium is more expensive.
"The best way to decide which tier works best for you is to analyze how often you expect to use your medical insurance. For example, if you have scheduled or need surgery, or if you know that you will need constant medical attention, it is better to choose a higher tier, for which you might pay a little more per month, but which covers more in the long run," Trish said.
Lupita Montalvo, 48 years old, signed up for the California state insurance program, called 'Covered California'. Although the bronze tier was very attractive due to the fact that her monthly payment would be one dollar, she opted for the silver tier.
"I don’t know how many times I’m going to need a doctor, but I don’t want to be paying more each time I need to go. With the plan I chose, I’m only going to pay $5 for the doctor’s visit and $75 if I need to go to the hospital or emergency room," Montalvo explained.
She already sent her payment for her first monthly premium of $44.25 to 'HealthNet'. Under the silver plan, she will have a copay of $5 for generic medicines and medical consultations, and it will cover 85% of hospital expenses. Her maximum annual payment for medical expenses will not exceed $2,200.
The monthly premium depends on a person’s age and the city where he or she lives. The federal subsidy level depends on the person’s income. In Montalvo’s case, if she had to pay the total insurance amount, her monthly fees would be $421, but since she qualifies for the federal subsidy, her monthly payment will be $44.25.
Trish explained that the federal subsidies are based on the silver tier.
"People can choose any tier and may receive the subsidy if they qualify, but the subsidy program is designed for the silver tier. This is the tier in which people can receive better value for their money," Trish said.
Laura Jaramillo, director of operations for 'L.A. Care', one of Covered California’s non-profit insurance companies, said the most popular tier among people who have opted for L.A. Care is the bronze tier.
"When it is time to choose a plan, the person needs to ask him -or herself how often am I going to need medical services. The more you go to the doctor, you should choose a plan that offers more coverage. The bronze plan is the least expensive, but it could be more expensive if the person requires constant medical attention," Jaramillo explained.
*Click here to view the original article in Spanish.