What Is Platinum Health Insurance?
Platinum health insurance is the highest tier of health insurance and is usually best if you have chronic or ongoing health issues.
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In exchange for high upfront costs, you'll have roughly 90% of your expenses covered.
A Platinum health plan will best fit you if you have serious or chronic health concerns. Expensive monthly premiums mean you'll get a low deductible, out-of-pocket maximum, copays and coinsurance. However, it probably won’t make good financial sense if you’re young or in good health.
What is Platinum health insurance?
Platinum health care insurance combines high monthly rates with low deductibles, out-of-pocket maxes, copays and coinsurance. It’s the most expensive of the four metal plan tiers created by the Affordable Care Act (ACA).
The four tiers differ by 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 expenses, and you pay roughly 10% out of pocket. However, you may pay more or less than that 10% figure since it’s an average cost that is not specific to every plan.
Cost sharing by metal 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 health insurance premiums don’t pay for medical care like doctor appointments or hospital bills. Your monthly premium only pays for the insurance policy. Generally speaking, the higher your monthly premium, the lower your insurance deductible, copays, coinsurance and out-of-pocket max.
Platinum insurance plans don’t provide better medical care than a Bronze, Silver or Gold plan. Instead, Platinum plans cost more up front but cover a higher percentage of expenses if you need medical care.
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 large health insurance companies offer Platinum plans. Of those that do, some top health insurance providers don’t operate in every region.
Only 14 states and Washington, D.C., offer Platinum coverage through their health exchanges.
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California
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Maine
- Maryland
- Massachusetts
- New York
- Rhode Island
- Vermont
- Virginia
- Washington, D.C.
- Wisconsin
What does Platinum health insurance cover?
The Affordable Care Act (ACA) requires most health insurance plans to cover certain medical expenses regardless of metal tier. You can get the same type of coverage from a Bronze, Silver, Gold or Platinum plan.
You can also modify your Platinum plan by purchasing supplemental insurance, which can fill in the gaps left by your Platinum health coverage.
Is Platinum health insurance right for you?
You won’t benefit from Platinum health insurance unless you have expensive and/or ongoing medical issues. 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 expenses to justify the more expensive premiums.
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 annual premium doesn’t erase your out-of-pocket savings.
Average health insurance cost by plan type
Metal tier | Annual rate |
|---|---|
| Bronze | $5,280 |
| Silver | $6,720 |
| Gold | $7,248 |
| Platinum | $8,844 |
To justify the higher cost, the Platinum plan would need an out-of-pocket maximum that’s at least $2,124 lower than the out-of-pocket max for a Silver plan. For example, you would be better off with the Platinum plan if the Silver plan had an out-of-pocket max of $6,500 and the Platinum plan had an out-of-pocket max of $4,000. In that case, your total annual cost would be $13,220 for the Silver plan and $12,844 for the Platinum plan — assuming that you hit your maximum.
It’s also worth noting that Platinum insurance plans qualify for ACA subsidies. That means you can defray a Platinum plan’s higher cost with premium tax credits if you're eligible.
Frequently asked questions
What is Platinum health insurance?
Platinum health insurance is the most expensive type of health care coverage you can purchase. You pay low out-of-pocket expenses for appointments and services, but high monthly premiums. Plans typically feature a small deductible or no deductible and cheap copays or coinsurance.
Is Platinum health insurance worth it?
Platinum health coverage might be worthwhile if you have very high annual medical expenses. However, if you don’t have significant, ongoing health issues, you’ll likely be better off with a less expensive form of health insurance.
How much does Platinum health insurance cost?
In 2023, the average monthly cost of a Platinum plan is $737 for a 40-year-old. Prices typically climb as you grow older. For example, at 65 years old you would pay an average of $1,730 per month for the same coverage.
Is a Platinum health plan better than a Gold health plan?
You’re better off with a Gold health plan if you’re OK with paying slightly higher out-of-pocket costs in exchange for a lower monthly premium.
Methodology
To compile this information, we used information from HealthCare.gov. We also accessed nationwide health insurance price data through the Centers for Medicare & Medicaid Services (CMS) to get average premium costs across all metal plan tiers. Rates are for a 40 year old non-smoker.
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