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ACA Plan Metal Levels – What They Are, How They Work

ACA Plan Metal Levels – What They Are, How They Work

Posted Nov 20, 2017 by Jenifer Dorsey

When the Affordable Care Act’s state-based and federally facilitated health insurance marketplaces opened for business on Oct. 1, 2013, we were introduced to a new way of selecting health insurance: by actuarial tier, aka metal level.

Meet the four ACA metal levels

All major medical health plans on the market today are categorized into four tiers by actuarial level—actuarial levels represent the percentage of total expected expenses paid for by the plan. Under the ACA, these tiers have been assigned a metal name: bronze, silver, gold or platinum.

The metal levels and their actuarial value percentages are as follows:

  • Bronze plan – 60% of covered medical expenses paid by the plan; 40% by the consumer
  • Silver plan – 70% of covered medical expenses paid by the plan; 30% by the consumer
  • Gold plan – 80% of covered medical expenses paid by the plan; 20% by the consumer
  • Platinum plan – 90% of covered medical expenses paid by the plan; 10% by the consumer

Which metal plan should you choose?

In general, the higher the share of covered medical expenses paid by the plan, the lower your out-of-pocket cost. However, this scenario also tends to translate into a higher premium.

You may want to choose a:

Bronze plan – If you are relatively healthy, typically see the doctor for preventive care and do not anticipate many medical expenses

Silver plan – If you tend to require a few trips to the doctor each year, take a prescription medication and want to keep your deductible a bit lower*

Gold plan – If you have health conditions that require ongoing medical attention, make frequent trips to the doctor and want to keep your deductible low

Platinum plan – If you want the lowest deductible possible and expect your medical expenses to be substantial

Some people qualify for a subsidy to help offset their ACA plan premium. Use our subsidy calculator to find out if you qualify.

What if you select a high-deductible plan and need healthcare?

While a low monthly premium can be appealing, they often come with the highest plan deductibles.

For instance, you could qualify for a no-cost bronze plan in Texas, but that bronze plan comes with a $6,400 deductible that must be met before your benefits fully take effect. You will pay out of pocket toward that amount.

One solution is to purchase additional benefits with the money you save on the premium. As we like to say, a supplemental plan can “make your bronze plan feel like gold.”

Supplemental plans such as Metal Gap 2 pay lump-sum benefits for covered accidents and illnesses. You can use these benefits however you choose, including medical bills before you reach your plan deductible, living expenses such as groceries and rent/mortgage, non-covered healthcare expenses and more. Coverage may cost as little as $1 per day.

Do plan benefits differ by metal level?

The ACA requires that all major medical insurance plans include the same minimal coverage for healthcare items and services in the 10 categories of essential health benefits. Carriers may choose to offer more than the minimum essential health benefits, however, and that is where plans could vary slightly.

Cost, including plan premium and deductible, will be the biggest difference you will notice between metal level. That is why it is important to shop with cost-sharing in mind and determine what share of covered medical expenses you and your family can afford if you need healthcare.

Health insurance companies are not required to offer plans for all four metal levels. That means certain carriers may choose to offer bronze and silver plans on the exchanges while others might offer only gold and platinum plans.

Work with a health insurance producer to determine what level of coverage might best suit your family’s budget and typical healthcare needs throughout the year. A local health insurance producer can help you explore and compare your benefits options both on and away from your state-based or federally facilitated health insurance exchange.