What are Enhanced Benefits?

The Affordable Care Act sets out to make health care more affordable by reducing health insurance premiums through advanced tax credits, known as premium subsidies and by lowering the out-of-pocket costs through cost-sharing reductions, or Enhanced Benefits.

There are four levels of Enhanced Benefits, known as Enhanced 73, Enhanced 87 and Enhanced 94.  The number refers to the average amount the health plan pays in expenses for covered benefits.  For example, Bronze plans pay 60% of health care costs on average, Silver plans pay 70%, Gold plans pay 80% and Platinum plans pay 90%.

Enhanced Benefits

Enhanced Benefits

If you qualify for an Enhanced Benefit plan, you are essentially getting a better plan for the cost of a Silver plan.  The federal government is subsidizing the cost to reduce your overall out-of-pocket costs when you seek medical care.  Co-pays, deductibles, co-insurance and out-pocket-maximums are reduced in the Enhanced Benefit plans.  A Silver plan has a $2,000 medical deductible, whereas an Enhanced 73 plan has a $1,5000 deductible, an Enhanced 87 plan has a $500 deductible and a Enhanced 94 plan has no deductible.

Qualifying for an Enhanced 87 plan provides you with better benefits than if you were to pay for a Gold plan, which on average would pay 87% of expenses versus 8o% with the Gold plan.  An Enhanced 94 plan provides better benefits than a Platinum plan, which on average would pay 94% of expenses versus 9o% with the Gold plan.

AUTHOR - Ali Nagy