Our 5-day example showed what hospital indemnity could pay for a 5-day stay on 2027 ACA plans. Here are four more situations, using the same plans.
The hospital indemnity plan could pay: $1,000 when admitted, $1,000 extra for an intensive care admission, $300 a day from day two, $300 extra per intensive care day, and $200 a day for a newborn's nursery stay (up to 2 days). All payouts assume the stay is covered and the claim is approved.
A week with intensive care
7 days in the hospital, the first 3 in intensive care, and a $60,000 bill.
- What you'd owe: on almost every plan, your yearly limit: $11,650 on California Bronze or Silver, $11,450 on Colorado Option Silver, $10,450 on Colorado Option Gold. The California flat-fee Gold plan charges $375 for 5 days: $1,875.
- Hospital indemnity could pay: $1,000 + $1,000 + 6 days × $300 + 2 intensive care days × $300 = $4,400.
That's about 38% of $11,650. Long stays and intensive care are where these plans pay the most.
Having a baby
A 3-day stay to give birth, with the baby in the nursery for 2 days:
- Mother: $1,000 + 2 days × $300 = $1,600
- Baby: 2 days × $200 = $400
- Total: $2,000
Checkups during pregnancy aren't covered by hospital indemnity, but the California ACA plans cover them at no charge.* More in hospital indemnity and having a baby.
A second stay in the same year
This plan pays the $1,000 admission payment once a year. A second 5-day stay in the same year could pay only the daily payments: $1,200 instead of $2,200. Other plans pay it several times a year if the stays are far enough apart. Check yours.
Lower incomes: when you already owe less
If your income qualifies for extra savings on a Silver plan, your costs drop a lot. Here's the same 5-day, $20,000 stay on California's 2027 plans with extra savings:*
| Plan | You pay | Share the $2,200 covers |
|---|---|---|
| Silver 94 | $1,150 | All of it |
| Silver 87 | $3,000 | 73% |
| Silver 73 | $6,000 | 37% |
On a plan like Silver 94, your health plan already does most of the work. See our open enrollment guide for how these savings work.
Not sure whether it's worth it for you? That depends on your income, your health plan and your savings, which is a lot to weigh at once. A licensed agent or broker in your state can help, and Marketplace shoppers can get free help through HealthCare.gov local help.
What it doesn't help with
Hospital indemnity pays only when you're admitted. It won't help with ER visits where you go home, outpatient surgery, scans, doctor visits or prescriptions. Other add-on plans cover different events; see supplemental health insurance explained.
Figure out your own gap
- Find your plan's deductible, hospital cost and out-of-pocket maximum in its Summary of Benefits and Coverage.
- Work out your share of a $15,000 to $25,000 stay.
- Add up what the hospital indemnity plan could pay for the same stay.
- Compare that with what the plan costs per year.
- Check the fine print before you sign up.
Sources
* California plans: prenatal visits are free on all of Covered California's 2027 standard plans, and the extra-savings Silver plans (94, 87 and 73) have no deductible, 10% to 30% for a hospital stay, and yearly limits of $1,150, $3,000 and $6,100. Covered California (PDF).
Colorado plan amounts come from the 2027 Colorado Option standard plans. Colorado Option plan summary (PDF). The hospital indemnity plan is a large national insurer's group outline of coverage for one employer.
