What Is the Difference Between the Metal Tiers?

Health insurance companies that sell plans on the Health Insurance Marketplace can offer four types of qualified health insurance plans, including Bronze, Silver, and Gold and Platinum. The plan you choose determines not only the premium you pay but also what portion of your health costs you pay.

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What Do the Health Insurance Tiers Cover?

Regardless of the plan you choose, it will provide all 10 essential health care benefits guaranteed to policyholders under the Affordable Care Act. The difference among the plans has to do with how much overall out of pocket costs you’ll pay up to your out-of-pocket maximum which is 80% for the Gold, 70% for the Silver and 60% for the Bronze.

Health Insurance Metal Tier Plans Explained

To make it easier to shop for coverage, health insurance plans have standardized “metals”. The “metal” plan depends on its actuarial value, or the average percentage of health care costs the plan pays vs what the member pays. The more coverage a plan provides, the higher the monthly premium and the fancier the metal level. Gold is better than Silver. Silver is better than Bronze.

  • Bronze plans cover 60% of your medical expenses
  • Silver plans cover 70% of your medical expenses
  • Gold plans cover 80% of your medical expenses

How Much Does Health Insurance Cost?

In general, Bronze plans have the lowest monthly premiums while Platinum plans are the most expensive. However, these plans are sold by private health insurance companies that set their own pricing. As a result, in some cases, a Gold plan sold by one health insurance company may have lower premiums than a Silver plan sold by another company.

Your health insurance premiums may also depend on your income, and for lower incomes, you could pay less at the hospital and doctor’s office too. If your income is below 250% of the federal poverty level, there are additional reductions on your out-of-pocket costs, like deductible and co-insurance and co-pays, but you MUST select a Silver plan. This is called “Cost Share Reduction”. This is in addition to the “Subsidy” that you receive to lower your monthly premium. For example, if your income is around 138% of the Federal Poverty Level, then you qualify for a large government subsidy, AND you if you enroll into a Silver plan, you’ll pay very small copays and deductibles because of the Cost Share Reduction.

When considering health care costs, it is important to consider not only the monthly premium, but also the actual medical expenses. If you know your medical expenses for the year are going to be significant, sometimes it’s best to enroll into a less costly plan, like a Bronze plan. Reason being, if you know you will reach the “out of pocket maximum”, then doesn’t it make sense to pay a lower premium each month? If it costs you less each month to get to the out-of-pocket maximum, mathematically, that may be the smartest way to go. On the other hand, if you are generally healthy and do not expect to need services beyond annual preventative care, a Silver tier, if you qualify for the Cost Share Reduction, may be the smartest way to go.

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How to Choose the Right Health Insurance Plan with Nevada Insurance Enrollment

Choosing the right metal tier requires evaluating your budget and assessing current and expected health care needs. At Nevada Insurance Enrollment, health insurance agents guide you in reviewing the options available across the tiers and help you determine which plan best fits your health needs and budget. We can also help you determine whether you qualify for subsidies to lower your premium.

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Health Insurance Is Expensive – What Is The Medical Loss Ratio?

 

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