A Comprehensive Overview on Gold-Metal-Tier Plans

ACA plans

With the passing of the Affordable Care Act, four metal-tier categories were also established to easily allow consumers to compare and shop for the qualified health plans offered by different insurance carriers. Thus the ACA plans are categorized in any of the four metal-tiers such as bronze, silver, gold, and platinum health plans. These four ACA plans are sometimes also referred to as metal plans, as they are referred to as Bronze, Silver, Gold, and Platinum plans. Health plans in all the four-metal tiers offer the same essential health benefits. The plan of different metal tiers differs in terms of the amount which the insured pays to receive the coverage and the benefits covered by the plan.

About Gold Metal-Tier Plans

A gold plan is a type of metal level plan offering a higher degree of health coverage in exchange for higher premiums. A gold plan offers the highest level of coverage and provides coverage for more healthcare services compared to a bronze or silver plan. Premiums of gold plans are the second most expensive among all metal tiers, however, sometimes the premiums of gold plans are less expensive than silver or bronze plans.

Gold plans generally have higher premiums but better cost-sharing compared to Silver or Bronze health plans and the gold plans also offer the second-lowest out-of-pocket costs among the standard Affordable Care Act plans. The gold plan provides the same essential benefits as plans of other types. Plans in each type of metal-tier have a certain set of benefits, costs, and services, and has a certain actuarial value.

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A Gold health plan has an actuarial value of 80%, it means that the health insurance carrier will pay 80% of the covered medical expenses up to the plan’s designated out-of-pocket maximum. Gold plans cover 80% of the covered healthcare costs while the remaining 20% is paid by the enrollees. The 80% figure is based on the government’s expectation of healthcare usage, and depending on the medical services that will be used by the enrollees. The remaining 20% of the healthcare costs are paid by the enrollees in the form of deductibles, copayments, and coinsurance fees. The out-of-pocket costs of the gold plan are paid in addition to the premium of the gold plan.

Few Characteristics of Gold-tier Plans

  • The gold plan is cost-effective, reliable in the long run that keeps enrollees safe. These plans are recommended to individuals who have a few healthcare needs such as pregnancy or some other intensive health maintenance.
  • Gold plans have high monthly premium but low costs when you need care. Though people are required to pay more in terms of monthly premiums their deductible will be low and so people end up paying less for illness or surgeries.
  • Gold Plans have the second-highest premium of the four metal-plans since these plans charge the second-lowest out-of-pocket costs. According to the Healthcare.gov marketplace, the average monthly premiums of Gold plans for 2020 across states were $501.
  • Gold plans have low deductibles, which is the number of medical costs you pay yourself before your carrier pays. The gold plan is of good value for you if you avail of a lot of medical care. It is also a good option if you are willing to pay a high premium to have more costs covered while receiving medical treatment.
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Costs associated with a Gold Health Plan

While choosing a health plan among different metal levels of plans, you must consider the total costs of the plans. This means that you should not only consider monthly premiums but also about out-of-pocket expenses as well. The following out-of-expenses also add to the potential cost of the health plans.

Copayments

It is the payments that you make each time on receiving a medical service after you have reached your deductible amount.

Deductible

It is the amount that you spend on covered medical services before your insurance carrier begins to cover the costs. Preventive services are an exception to this rule, as the cost of preventive services will be paid by your insurance carrier in your gold health plan.

Out of pocket maximum

It is the maximum amount that you will spend for the covered medical services for an entire year. Once you have reached your deductible amount, your insurance carrier will pay for 100 percent of covered medical expenses.

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