Summary Cost Data for Health Plans Available in Georgia’s Exchange, 2014: Fact Sheet Page: 2 of 6
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Summary Cost Data for Health Plans Available in Georgia's Exchange, 2014: Fact Sheet
The Patient Protection and Affordable Care Act (ACA, PL. 111-148, as amended) contains a
number of provisions that may affect the individual health insurance market. These
provisions may alter the amounts that individuals and families can expect to pay for
insurance plans sold on Georgia's exchange. This fact sheet provides a look at selected costs and
options for individual and family plans in Georgia's exchange.' (For background information, see
the related overview report, CRS Report R43484, Summary Cost Data for Federally-Facilitated
Exchanges, 2014).
A state resident interested in purchasing an individual plan in his or her exchange may have a
choice of plans that vary in characteristics, such as the share of medical spending the plan will
cover ("actuarial value," or AV2), the scope of the benefits package (e.g., types of services and
providers covered), and other plan features.3 Under ACA, each plan that meets a specific AV is
designated by a precious metal: platinum, gold, silver, or bronze.4 Exchanges are also allowed to
offer catastrophic plans, with AVs below 60%; such plans are available only to individuals under
the age of 30 and certain others who are exempt from ACA's individual mandate.' Given this
potential range in plans, this fact sheet displays premium and cost-sharing data tables for five
categories of health plans, in order of decreasing actuarial value: platinum to catastrophic.
A person or family seeking health insurance faces a tradeoff between the expense of premiums
and cost-sharing requirements. For example, a younger resident expecting to use relatively few
medical services may prefer a lower-tier plan. Although lower-tier plans in general have smaller
premiums, they also have greater cost-sharing requirements, overall. Table 1 summarizes selected
premiums for individual insurance plans available in this state for adults at different ages, and
Table 2 shows selected cost-sharing requirements of the same plans.
Table I. Monthly Exchange Premiums for Individuals, for Selected Ages
(premium amounts are rounded to the nearest dollar)
Single Adults, Age 21 Single Adults, Age 40 Single Adults, Age 60
Metal Level Min. Mediana Max Min. Median Max Min. Median Max
Platinum $230 $251 $303 $295 $321 $387 $625 $681 $822
Gold $204 $309 $490 $261 $395 $626 $555 $839 $1,330
Silver $179 $260 $391 $229 $333 $500 $486 $706 $1,062
Bronze $156 $213 $344 $200 $273 $439 $424 $579 $933
Catastrophicb $121 $143 $246 $155 $183 $315 $329 $388 $668
1 The data analysis for this report was conducted by CRS using a publicly available data set from Data.Healthcare.gov.
2 Actuarial value (AV) is a measure of a plan's generosity, expressed as the percentage of medical expenses estimated
to be paid by the insurer for a standard population and set of allowed charges. In other words, the higher the percentage,
the lower the cost-sharing, on average.
3 For descriptions of the variety of health plans that may be offered inside (and outside of) exchanges, see CRS Report
R43233, Private Health Plans Under the ACA: In Brief
4 Platinum plans have an actuarial value of 90%; gold plans, 80%; silver, 70%; and bronze, 60%.
5 ACA authorizes the Secretary of Health and Human Services to provide exemptions from ACA's individual mandate
to individuals who have suffered hardship with respect to the ability to obtain coverage under a qualified health plan.
This authority gives the Secretary wide discretion as to what constitutes a hardship, and the individuals and families
who qualify for such exemptions. The ability for exempted individuals andfamilies to enroll in a catastrophic plan
offered through an exchange does not depend on their age.Congressional Research Service
1
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Summary Cost Data for Health Plans Available in Georgia’s Exchange, 2014: Fact Sheet, report, April 24, 2014; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc807850/m1/2/: accessed April 23, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.