metal levels

Health Plans Types

Health plans are designed in different ways and for different customer segments. For example,  They can be defined by network characteristics (i.e. PPO, HMO etc.) or customer target (individual health plan, group health plan, etc.).  In the new Obamacare environment they can also be defined by their “metal level”  — or actuarial value.  The various metal levels set forth in the affordable care act are defined below.

 

Metal Levels

Depending on the number of health plans that are offered in your on your designated exchange (either healthcare.gov, or state exchange) you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, Platinum, or Catastrophic plans.

Bronze:

Bronze plans tend to have the lowest monthly premiums (not including catastrophic plans). Bronze plans cover an average of 60% of all your covered out-of-pocket costs while you are responsible for the remaining 40%.

Bronze plans qualify for premium tax credits.

Silver:

Silver plans tend to have the second lowest monthly premiums. Silver plans cover an average of 70% of all your covered out-of-pocket costs while you are responsible for the remaining 30%.

Silver plans qualify for both premium tax credits and cost sharing subsidies.  (Silver plans are the only types of plans to qualify for cost sharing subsidies.)

Gold:

Gold plans tend to have the second highest monthly premiums. Gold plans cover an average of 80% of all your covered out-of-pocket costs while you are responsible for the remaining 20%.

Gold plans qualify for premium tax credits.

Platinum:

Platinum plans tend to have the highest monthly premiums. Platinum plans must cover an average of 90% of all your covered out-of-pocket costs while you are responsible for the remaining 10%.

Like bronze, silver, & gold plans, platinum plans also qualify for premium tax credits.


cost sharing by metal level

 

Catastrophic coverage:

Catastrophic health plans are the least expensive plans you can get that count as minimum essential benefits. If you are under 30 or obtained a “hardship exemption” you qualify for high deductible, low premium, catastrophic plans. These have extremely high out-of-pocket costs.

Catastrophic coverage plans do not qualify for premium tax credits.

 

other information you may be interested in: qualified health plans, off-exchange plans, individual coverage plans