Gold Health Insurance Plan: What does it cover?

Updated: November 21, 2022
Gold Health insurance Plan

A type of individual and family health insurance plan known as a gold health insurance plan pays 80% of the covered medical expenses, with the policyholder responsible for the remaining 20%. The deductible, copayment, and coinsurance payments make up the portion of the cost that is your responsibility. It’s a health insurance option after a platinum plan and typically offers more coverage than a silver or bronze plan.

A gold health plan typically costs more than a silver or bronze plan, though cost-sharing reductions occasionally cause them to be comparable in price. For the price of silver, you can purchase gold-plated health insurance. Even though they could have a higher health insurance premium, gold plans frequently have lower out-of-pocket expenses, making them more cost-effective.

Please continue reading to learn more about gold medical insurance, how much it typically costs, and whether a gold plan is the best option for your healthcare requirements.

Compared to other metal levels, gold health insurance plans.

The four health insurance tiers are referred to as the metal levels. They are Bronze, Silver, Gold, and Platinum.

While platinum provides the most coverage options and the highest split, bronze gives the most affordable primary health care with the lowest insurer-to-insured ratio. The resources page for the Affordable Care Act has more information. What to anticipate from each metal level is shown below.

Bronze Plan

The bronze level provides a 60/40 split for coverage after the deductible has been reached and is also the least expensive of all the levels. Deductibles for the bronze plan are costly. Those who want health care coverage for the worst-case scenarios should choose a plan like this one, which is a step above catastrophic coverage.

Silver plan

A silver-level plan offers more coverage at a lesser cost than a bronze-level plan but also has a higher monthly premium. The coverage split for silver plans is 70/30. Deductibles are typically lower as well, and you can reduce the cost of medical treatment even further if you are eligible for cost-sharing reductions. The cost-sharing discounts, however, are only accessible at the silver level.

Gold Plan

Although a gold plan often has a high monthly premium, in some places, it might be just as expensive as a silver plan. These plans feature less expensive deductibles and healthcare expenditures. An 80/20 expense split applies to a gold plan.

Platinum Plan

Platinum offers the most comprehensive healthcare coverage at the most expensive level of all the plans. The cost split is 90/10, and the deductibles are the lowest. A platinum plan makes the most sense for those who require ongoing medical care and need the certainty that nearly all costs will be covered.

What is the average cost of a gold health insurance plan?

Your current state of residency affects the cost of your gold health insurance. In 2022, the average cost of gold medical insurance across all 50 states will be $462, according to the Kaiser Family Foundation (KFF). States vary in price, with some being more expensive than others. For instance, a gold plan typically costs $464 in Illinois, $839 in Virginia, and $296 in Maryland. The tax credit now covers a larger portion of the premium cost than in previous years, as evidenced by the rapid decline in gold plan premiums.

How much does a gold health insurance plan’s typical subsidy cost?

Numerous variables affect the typical subsidy for a gold health insurance plan. You can apply for the assistance, sometimes referred to as the advanced premium tax credit, during Open Enrollment. It is essential to remember that the tax credit is not automatically applied, and the amount you receive depends on the income information you provide on the application.

You can pay your premium in full and obtain a tax deduction for the cost of your premiums, or you can take the credit as a monthly payment toward your premium. The average monthly subsidy for a 30-year-old earning 150% of the federal poverty level (FPL) ($20,385) is $342, while the average monthly subsidy for a 30-year-old earning 300% of the FPL ($40,770) is $149.

A gold plan costs $120 per month for someone at 150% of the FPL and $313 for someone making 300% of the FPL.

If you research “how much is gold health insurance?” you’ll discover that your income and the federal poverty level multiplier determine the cost. It can be anything between 150% and 400% of your salary. Usually, the multiplier increases as your income decreases.

What additional expenses are there for a gold health plan?

Consider the overall cost to your health whether you choose a gold level or another metal. This implies that while selecting your insurance plan, you must consider factors other than your monthly price. For instance, you should consider out-of-pocket fees and the list of prospective charges below.

  • Copayments – Once your deductible has been met, you must pay a copayment each time you receive medical care.
  • Deductible – Before your insurance company begins to pay for covered medical services, you must pay the deductible. The later criterion is frequently broken by preventive services, which are frequently covered by your gold health plan.
  • Out-of-pocket maximum – This payment denotes the maximum amount you will pay out-of-pocket for covered medical services in a calendar year. Your insurance company will frequently cover your eligible medical costs if your deductible is met.

What is the value of a gold health insurance plan?

Gold medical insurance is worthwhile if you anticipate needing extensive medical care over an extended period of time. Overall, you’ll spend less on doctor visits, medicines, and specialist visits. Although the premiums for a gold health plan are expensive, they are more affordable compared to the out-of-pocket expenses for silver and bronze policies. Cost-sharing decreases have made gold health plans less expensive in recent years.

A gold health plan is not worth the money if you are in good health and don’t need frequent medical attention. You might not require the level of protection provided by gold medical insurance, which would mean paying more premiums for the protection you wouldn’t use.

Why Choose the Gold Option?

Suppose you are willing to pay higher premiums in exchange for your health insurer covering a larger amount of your medical bills. In that case, a gold-tier plan may be a viable alternative. A gold plan is ideal if spending less out-of-pocket when using your health plan appeals to you in exchange for paying higher premiums.

Gold plans are more likely to appeal to individuals who want to utilize their health insurance, are concerned about high out-of-pocket costs, and can afford to spend a little more each month for a little more peace of mind than they would with a silver or bronze plan.

However, as stated previously, some individuals on the individual market may find it more advantageous to acquire a gold plan because it is less expensive than a silver plan while still giving higher coverage. This has been the case since 2018, when the cost of CSR was added to the silver plan premiums, resulting in disproportionately high prices for silver plans.

(Notably, the available silver plans on the exchange will be modified to have actuarial values well above 80%, meaning they will provide more comprehensive coverage than gold plans for individuals who qualify for cost-sharing reductions and earn below 200 percent of the federal poverty level; this is discussed in greater detail below.)

Unless laws are modified to prevent insurance holders from adding the cost of CRRs to silver plan premiums, this pricing structure — which results in gold plans being priced less than silver plans in some locations — might persist indefinitely. In 2019, Congress intervened to prevent HHS from prohibiting insurers from including the cost of CSR in 2021 silver plan premiums. HHS has contemplated modifying the standards governing how CSR charges can be added to premiums.

Therefore, it is anticipated that silver plan premiums will stay disproportionately expensive for the foreseeable future (which also results in large premium subsidies).

Silver plans have an actuarial value considerably above 80% for CSR enrollees with incomes below 200% of the federal poverty threshold. The actuarial value of the accessible silver plans will be 94% for households earning up to 150% of the federal poverty level and 87% for households earning between 151% and 200% of the federal poverty level.

A gold plan will provide broader coverage for individuals who do not qualify for cost-sharing reductions (i.e., whose income is above 250% of the federal poverty level or $32,200 for a single individual purchasing coverage for 2022). It may have lower rates, depending on the region.

(It should be noted that while CSR benefits are available to applicants with incomes up to 250% of the poverty level, individuals with incomes below 200% of the poverty level receive the largest benefits.) The CSR benefits increase the actuarial value of a silver plan by a small amount, from 200% to 250% to 73%.

If you work for a small business and are offered multiple metal plans in addition to a gold plan, you should carefully compare all of your options to find the one that suits you best. Since group health plans do not cover CSR, its cost is not a factor in the employer-sponsored market. Consequently, gold employer-sponsored plans typically cost more than bronze and silver plans but less than platinum plans offered by the same insurer (though costs vary greatly among insurers; for instance, Insurer A’s gold plan may cost less than Insurer B’s bronze plans).



What distinguishes the silver from the gold plan?

Your out-of-pocket expenses will be less than a bronze plan but more than a gold plan unless you qualify for a cost-sharing reduction. Your monthly payments will be less than a gold plan but more than bronze—lower out-of-pocket expenses with larger monthly payments under gold plans.


What is covered by the gold plan?

A type of individual and family health insurance plan known as a gold health insurance plan pays 80% of the covered medical expenses, with the policyholder responsible for the remaining 20%. The deductible, copayment, and coinsurance payments make up the portion of the cost that is your responsibility.


What are the benefits of the gold plan?

This is one of the Health Insurance Marketplace’s 4 health plan types (or “metal levels”). Gold plans often offer higher monthly premiums but less expensive out-of-pocket medical expenses. Gold might be a smart option if you use many medical services or would prefer to pay more upfront and know that you’ll pay less when you receive care.


Is it worth a gold hospital cover?

If you have debilitating ongoing health issues or chronic diseases, consider going for gold. For instance, it is a level of hospital insurance advantageous to patients requiring insulin pumps and dialysis for kidney disease. Or if you have a specific type of cancer and require ongoing care.


Do gold health plans outperform silver ones?

Gold health plans feature greater premium prices but lower out-of-pocket expenses than Bronze or Silver plans. Deductibles are significantly reduced. A Gold plan is more likely to save money than a Silver or Bronze plan if you frequently utilize medical services.


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