Understanding Health Insurance Metal Levels

California Health InsuranceThere are many options to consider when buying Health Insurance. The Affordable Care Act (ACA) has made it simpler to compare plans by requiring insurance companies to offer plans that fall into one of four levels of coverage for individual and small group plans. The four categories are named after metal levels: bronze, silver, gold and platinum . The idea is to arrange plans into tier levels based on the level of care provided and therefore premium charged.

How to Understand the Level or Tier The quality of health care provided has no bearing on the tier or level of insurance purchased. Health plans in each tier are required to include a core set of benefits, called essential health benefits, as outlined in the Affordable Car Act.. Benefits may include coverage for emergency room care, hospital stays, maternity and newborn care, prescription drugs and preventive care. The important difference is that plans in each tier pay different amounts of the total cost of a healthcare. Each plan will fit into one of the four tiers (metal levels); each of these plans will have a different premium, deductible, copayments, coinsurance and out of pocket maximums.

For example, bronze plans have the lowest monthly premiums, but the members’ cost-share responsibility in this tier is higher when they get health care services. Platinum plans have the highest monthly premiums, but members pay lower cost share amounts.

Four coverage levels  The following is the co-insurance break down for each tier:

  • Bronze: health care plan pays 60%, member pays 40%
  • Silver: health care plan pays 70%, member pays 30%
  • Gold: health care plan pays 80%, member pays 20%
  • Platinum: health care plan pays 90%, member pays 10%

Which Plan Should I Buy? When considering which plan to buy, it is wise to review the following:
The tier level not only affects the premium but more importantly how much the patient pays for doctor visits, hospital visits or prescription drugs. In addition to the required benefits for each tier level, different plans may offer coverage for other services as well. In summary, not every plan is identical even within the tier level and each company may offer additional services on the plans at different costs. It is also important to consider the provider network available and if your current physician(s) subscribe to the network.

  • If you go to the doctor often or need regular prescriptions: a gold or platinum plan may be best. While these plans may cost more, they also pay more of the costs when you need care.
  • If you don’t go to doctors very often or take regular prescriptions: a silver or bronze plan may be best. These plans cost less per month, but they also pay less of the costs when you need care.
  • For more details, visit our health care page.