Metallic "Metal"Health Plan Tiers



 

This article will describe the different levels: bronze, silver, gold, platinum and provide recommendations on those who can benefit from the corresponding levels of coverage.


Individual, Family, & Small Business coverage all follow the metallic tier format so it is likely you have heard of, or have been on, one of these levels of coverage.

Essential (Universal) Health Benefits


Before I talk about the difference between the levels of coverage I would like to explain some of the most important benefits you receive, regardless of the level of coverage you are on or end up selecting.


Since the passage of the ACA or "Obamacare" all carriers are required to follow certain guidelines when creating plan to sell on the health insurance market. Apart of that mandate was the 10 Essential Health benefit's. This list will try to tie together some of the common benefits across the 4 tiers of coverage that stem from those 10 EHB's.


  1. Every plan will have an out of pocket maximum (OOPM) which is the total amount any health insurance company can legally charge an insured for covered health services for the plan year. This does not include the premium payment.

  2. Preventative visits and services will be no cost (Annual Physical, Immunizations, some Screenings/Labs) regardless of the level of coverage. Consult with you provider and your insurance company before setting any appts.

  3. All plans include pediatric services, dental, and vision. Those insured under the age of 19 can receive dental check up exam, vision services one yearly exam, directly through the medical plan.



Bronze

Lowest cost coverage as far as premium.

Highest cost when you seek covered medical services.


Typically designed to require a significant amount of upfront cost before services are covered by the insurance company.


Good for those who are concerned with coverage and protection for the worse case scenarios such as serious illness, hospitalization, or injury. Also, for those who have low utilization and do have frequent doctor visits or prescriptions.

Silver

Moderately priced premiums. More routine care cost covered up front and moderate cost for other services.


Typically silver plans have lower deductibles, the cost you pay for services before the insurance company pays, and have more services covered by up front co-pays.


Silver plans can cost more then bronze plans but can save you money down the line depending on your medical needs. Many times if you qualify for "Extra Assistance", silver plans can be the best options to utilize extra savings.


Good for those who need multiple routine or specialist visit throughout the year. If you qualify for assistance these plans receive the most benefit.


Gold

Higher premium but lower cost for services.


Typically are built with low deductibles and co pays for most services. Most significant is out of pocket maximums (OOPM) start to drop significantly at this level. So while premiums do raise so does the overall financial protection.


Good for those who anticipate to utilize a lot of services. If you are willing to pay more monthly you will have lower cost when you seek services.


Platinum

Highest premium of all tier and lowest cost for covered treatment.


Typically have low deductibles if, any at all, and out of pocket maximums are slightly lower then gold plans.


Good for those who are already paying significant amounts of money with no insurance or anticipate high utilization of benefits. If you can pay more a month for coverage you will pay much less when you seek services.


Need help figuring out what coverage level is best for you?


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