When Obamacare became THE law, that was the point that consumers could begin shopping for health insurance on the state-based and federally facilitated health insurance exchanges. The plans sold in what has been called the Health Insurance Marketplace (or Exchange) are classified into four tiers by actuarial value – the percentage of total expected medical costs paid by the plan. These Obamacare coverage tiers have been unofficially dubbed the “metal levels” or “metal plans”.
While the Affordable Care Act requires that all plans include the same minimal coverage for health care items and services in 10 essential health benefits categories, plan costs will vary depending on which metal level is selected. Consumers shop with cost-sharing in mind and determine what share of covered medical expenses they can afford.
Those so-called “metal levels” and their actuarial value percentages are as follows:
Bronze plan – 60 percent of covered medical expenses paid by the plan; 40 percent by the consumer
Silver plan – 70 percent of covered medical expenses paid by the plan; 30 percent by the consumer
Gold plan – 80 percent of covered medical expenses paid by the plan; 20 percent by the consumer
Platinum plan – 90 percent of covered medical expenses paid by the plan; 10 percent by the consumer
How do they work? The higher the share of covered medical expenses paid by the plan, the lower the consumer’s out-of-pocket cost. However, this scenario also translates into a higher premium. if you are relatively healthy and do not anticipate many medical expenses, a bronze or silver plan may be the right solution. If you have health conditions that necessitate frequent care and services, you may find it advantageous to select a gold or platinum plan.
Those who opt for the silver plan and who incomes fall below 250 percent of the federal poverty level will receive cost-sharing subsidies – there are in addition to any tax credit for which you may be eligible. Cost-sharing will be automatically applied based on income and will help with the cost of deductibles, copayments, coinsurance and total out-of-pocket spending limits.
Obamacare’s metal plans may share basic benefits and include the same actuarial values, but they will not be identical. All health insurance plans must fit within the tiered structure, but carriers can choose to offer more than the minimal essential health benefits. As such, it is important to compare plans and carefully consider which is best for you and your family.
Also note that health insurance companies are not required to offer all four metal levels. That means certain carriers may choose to offer bronze and silver plans on the exchange while others might offer only gold and platinum. Monthly premiums will vary based on factors such as age and region. With the Affordable Care Act, it is illegal for insurers to deny coverage or charge applicants more based on medical history. They must also cover care for preexisting conditions.
Yep, just another set of variables, but the good news is that we can help you to figure out all the hard stuff – just give us a call at (615) 541-4257 or request a call online – we’re here to help you.