Subsidy Eligibility

Understanding Your 2020 OptimaFit® Individual & Family Health Plan Options

Individual health plans offer a variety of price options and are categorized by metallic tiers: Gold, Silver, and Bronze.

Categorizing plans by metallic tier makes it easier for you to compare plans based on their cost and coverage options. If you do not qualify for a subsidy, you may want to consider plans not offered on HealthCare.gov, also known as "Off-Exchange" plans.

This chart provides an overview of health plan tiers to help you determine which metallic plan would be best for you.

Gold Silver Bronze
Monthly Premium $$$ $$ $
Percent of Healthcare Cost Covered 80% 70% 60%
Good If... You want to save on premium costs, while still reducing your out-of-pocket costs. You need to balance monthly premium costs with out-of-pocket costs.* You don't plan to use a lot of healthcare services.

Could You Qualify for a Premium Tax Credit in 2020?

If your income is between 139% and 400% of the Federal Poverty Level, you may get tax credits, also known as subsidies, to help pay for health insurance coverage.

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Savings Depends on Income and Household Size

Household Size Income1
1 $17,361 - $49,960
2 $23,504 - $67,640
3 $29,648 - $85,320
4 $37,792 - $103,000
5 $41,936 - $120,680
6 $48,080 - $138,360
7 $52,903 - $138,360
8 $60,367 - $173,720

Things to Consider

If you don't anticipate you will need a lot of healthcare services, you may want to consider a bronze or silver plan for a lower monthly premium.

However, if you or a family member have a serious injury or illness, a bronze or silver plan will require higher out–of–pocket costs for treatment. With a silver or bronze plan, you pay less on a monthly basis but may pay more for treatment. With a gold plan, you pay more on a monthly basis but much less for treatment.

1Department of Health and Human Services (HHS) Poverty Guidelines for 2019, www.aspe.hhs.gov/poverty-guidelines

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Optima Health has plans with different network coverage options for 2020.

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