Health insurance plans that are available on the U.S. marketplace are divided into four levels that are named after popular metals. The Affordable Care Act not only standardized the health benefits that all individual and small group plans must cover, but also divided these plans into different metal tiers so that individuals can easily compare different plans and find the best plan in their budget. The four tiers of health insurance plans that are available on the market are bronze, silver, gold, and platinum. Health plans are categorized into any of these tiers based on how the health insurance carrier split the healthcare costs with the insured.
Coverage under Each Metal-Tier
Individuals shopping for health insurance plans need to understand that health plans in all the metal-tiers cover the same ten essential health benefits and the quality of medical care remains the same in all the tiers. Irrespective of the plan-tier, enrollees of the health insurance plans have access to the same network of doctors regardless of the metal-tier of plan they have enrolled. The plan metal-tiers only indicate the splitting of cost of the plans between the insurer and the insured. In order to be approved as a qualified health plan in a specific metal tier, the plan needs to cover a specific percentage of an individual’s health care costs, which is also referred to as the plan’s actuarial value. The amount covered by health plans in each metal-tier are:
- Bronze plans cover 60% of the insured healthcare costs
- Silver plans cover 70% of the insured healthcare costs
- Gold plans cover 80% of the insured healthcare costs
- Platinum plans cover 90% of the insured healthcare costs
Difference Between Each Metal-Level of Plans
Bronze is a metal-tier of plan that has the lowest monthly premium of all metal tiers. However, individuals need to be aware that they will require to pay the highest costs when receiving medical care. Besides, Bronze plans also have the highest annual deductibles and individuals may end up paying several thousand dollars out-of-pocket before they start receiving the benefits. Bronze plans are ideal only for those individuals who are healthy, looking for a cost-effective way to obtain coverage and do not expect to receive much of medical care in the coming year. Individuals enrolled in the Bronze plans get 60% of their healthcare costs paid by their insurer and the remaining 40% is paid by them.
The Silver metal-tier of plans has moderate monthly premiums and even members of the Silver plans have to pay moderate costs when receiving medical care. Besides the annual deductible is lower with the Silver plan compared to Bronze. The best thing about the Silver plan is that based on their income and family size, individuals may also qualify for cost-sharing reductions that could save them thousands of dollars a year when they will need to access lots of healthcare services. Thus, the Silver plan is ideal for those individuals who think that they will require must of medical services and who can qualify for cost-sharing reductions. Health insurance carriers pay 70% of the healthcare costs, and the remaining 30% is paid by the individuals enrolled in the Silver plans.
Gold is a type of metal-tier of plans that have high monthly premiums but costs less when individuals need to access healthcare. Besides, Gold plans have very low deductibles and it means that plan will pay for 80% of the covered healthcare costs and the remaining 20% of the medical expenses will be paid by the individuals themselves. The Gold plan is ideal for individuals who expect to access a lot of health care in a given year and who can afford to pay a high monthly premium. Thus, such individuals will get the most value out of their Gold plan.
Platinum is a metal-tier plan that is known to have the highest monthly premiums and the lowest cost when the individuals enrolled in the plan actually access healthcare. Platinum plans also have the lowest annual deductibles of all the metal tiers. It means this plan is ideal for those individuals who expect to access a lot of healthcare services and can afford the high costs of the monthly premiums. Platinum plans pay for 90% of the covered healthcare costs and the members enrolled in the plan are supposed to pay only 10% of their medical expenses.
Thus, Gold and Platinum plans usually have higher premiums, but these plans pay more of their care if the members of these plans become sick. Platinum plans come with the highest premiums, but individuals need to know that they will pay much less out of their pocket at the time of receiving health care. Bronze plans generally have the lowest premiums, but members of the plan end-up paying more out of pocket before their carriers start paying for some of their medical expenses. Platinum plans have the highest premiums, but carrier pays more and may offer coverage for more health care services.