If you are a California resident needing health insurance, you might be familiar with the Enhanced Silver plans offered by Covered California. Among the different plans available on Covered California, Silver Plans are the most popular. These plans have reasonable premiums, deductibles, copays, and copayments. If you don’t require frequent medical attention and want a balance between your monthly plan premiums and out-of-pocket costs, then Silver Plans are a great option.
How do I Qualify for the Enhanced Silver plans?
Covered California offers three Enhanced Silver plans: Silver 73, Silver 87, and Silver 94. Depending on your chosen plan, these plans cover 73% to 94% of your healthcare costs. The Enhanced Silver plans provide the same benefits but differ in monthly premiums and medical services expenses.
However, not everyone is eligible for Enhanced Silver plans. To qualify, you must sign up through Covered California and meet their income requirements based on your age, family size, and zip code. Generally, to be eligible for Enhanced Silver plans, your income must be between 138% and 250% of the federal poverty level. You may be eligible for cost-sharing reductions with an Enhanced Silver plan if you meet this requirement.
Enhanced Silver 73 Plan
This plan is one of the Silver Enhanced Plans, and it comes with the lowest level of cost-sharing reductions. It is available only to those who meet the eligibility requirements of Covered California. Starting from 2024, the Silver 73 Plan will have a copay of $45. For medical services, the deductible for individuals is $4,750, and for prescription drugs, it is $30. For families, the deductible is $9,500 for medical services and $60 for prescriptions.
Enhanced Silver 87 Plan
The Silver 87 plan covers approximately 87% of your healthcare expenses. It is available to individuals who meet the Covered California eligibility criteria. Starting from 2024, the plan offers a copay of $15. The deductible for medical services is $1,400 for individuals and $2,800 for families. For prescription drugs, the deductible is $100 for individuals and $200 for families.
Enhanced Silver 94 Plan
This plan provides the highest level of cost-sharing reductions and is available to those who meet Covered California’s eligibility requirements. Starting from 2024, the Silver 94 plan will have a $5 copay.The individual deductible is $75 and $150 for a family. However, there is no deductible for prescription drugs. The Silver 94 plan is one of the best options to enroll in if you qualify for it.
Note: There is no deductible for dental care for all Silver Enhanced Plans
Key Terms to Know
COPAY- A copay is a fixed amount for a specific medical service. For example, The Silver 73 Plan will have a copay of $45 for a doctor’s visit. This means you’ll pay $45 every time you see a doctor, regardless of the total cost of the visit.
DEDUCTIBLE – Your deductible is the amount you must pay out of pocket before your insurance starts covering your medical costs.
PREMIUM – Your monthly premium is the amount you pay for your health insurance coverage. This is a set fee you pay regardless of whether or not you use your insurance.
Is an Enhanced Silver plan the right choice for me?
Enhanced Silver Plans are a type of health insurance plan offered under Covered California that provides additional cost-sharing reductions to eligible individuals, making them a more affordable option for healthcare. However, not everyone is eligible for these plans, and to qualify for Enhanced Silver plans, your income and household size must meet certain requirements. If you meet the eligibility criteria for Enhanced Silver plans, they are an excellent choice for you. It’s important to keep in mind that if your income increases in the future, you may no longer be eligible for the Enhanced Silver Plan.
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