Whether you shop on or away from your state’s Obamacare exchange, you will select a qualified health insurance from one of four metal plan levels—bronze, silver, gold and platinum. These are often referred to as the Obamacare metal plans.
Obamacare’s metal levels can help streamline your health insurance shopping experience by making it easy to narrow your options. They can also create confusion if you are not informed about how they work. Read on for a quick metal plans primer and to learn how to find your metal match.
How are the metal plans different?
The Obamacare metal plans are identical at the core. They do not reflect quality of coverage or care. All metal plans must meet the same Affordable Care Act requirements, which include the 10 categories of essential health benefits, certain preventive care services at no additional cost, the inability to deny applicants coverage or charge them more based on health history, and so on.
Where they vary is in actuarial value, which represents the share of healthcare expenses a health insurance plan covers for a typical group of enrollees.1 Each metal plan breaks down cost sharing between the health insurance plan and the covered individual a bit differently. These cost-sharing percentages include monthly premium, deductible, copayments, coinsurance, and out-of-pocket expenses. 2
The average percentage of covered healthcare expenses by metal plan breaks down as follows:3
While all Obamacare plans must include the same basic benefits, which are determined by a state-selected benchmark plan, they may vary beyond those requirements. For instance, networks, prescription drug formularies and coinsurance percentages will differ from plan to plan.
How to choose the right Obamacare metal plan
Now that you know a bit about how metal plans work, you must decide which is right for you. This requires considering your healthcare budget and healthcare needs, as well as the healthcare needs of any family members who will be covered by the plan.
In general, a bronze plan will have the lowest monthly premium rate and the highest annual deductible; a platinum plan will mean a highest monthly premium rate and the lowest annual deductible. Finding the right balance between premium, deductible and out-of-pocket costs is key to getting the most affordable health care.
The chart below provides a general picture of how the metal plans differ and who might benefit the most from each.
It can be helpful to consider this: If you require care beyond the preventive services covered at no additional cost under the Affordable Care Act, you must meet your deductible before benefits kick in. Will you be able to fulfill the deductible you select if you require expensive medical care?
When selecting a plan, factor in your healthcare budget, the frequency at which you typically need medical care, whether or not you take prescription drugs on a regular basis, what you spent on healthcare in the past year (including premium, copayments, non-covered expenses, etc.), and if your healthcare needs will change in the year ahead. Refer to these numbers when shopping for a metal plan.
Which metal plan is the most popular?
The silver plan seems to be America’s favorite. This may be largely in part to the fact that income-based cost-sharing subsidies are only available to individuals and families who enroll in a silver plan. It could also be that of the four metal plans, it tends to strike the closest balance between affordable monthly premium and manageable annual deductible.
In 2014, percentage of Obamacare exchange enrollees by metal level broke down as follows:
- Bronze – 20%
- Silver – 65%
- Gold – 9%
- Platinum – 5%
- Catastrophic – 2%
Are metal plans available in the private marketplace?
Not all companies will offer all metal plans, but all metal plans will be present on and away from the state-based and federally facilitated health insurance exchanges.
Financial assistance in the form of premium tax credits and cost-sharing subsidies are available to those who buy health insurance coverage from the state-based and federally facilitated exchanges and qualify based on income and family size.
What about catastrophic health plans?
Catastrophic plans are only available to those who are younger than 30 years old or qualify for a hardship exemption or are under 30 years old.
Visit HealthCare.com for more information on health insurance options and the Affordable Care Act.
Obamacare Insurance Plans related articles:
- What Is the Difference Between On- and Off-Exchange Health Insurance Plans?
- How Obamacare Medicaid Expansion Affects Americans
- Top 2017 Obamacare Enrollment Checklist
1 The Henry J. Kaiser Family Foundation. “What the Actuarial Values in the Affordable Care Act Mean.” KFF.org. April 1, 2011. Retrieved from http://kff.org/health-reform/issue-brief/what-the-actuarial-values-in-the-affordable/
2 U.S. Centers for Medicare & Medicaid Services. “Marketplace Insurance Categories.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/how-do-i-choose-marketplace-insurance/plans-categories
4 U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment: For the Period: October 1, 2013–March 31, 2014 (Including Additional Special Enrollment Activity Reported through 4-19-14). May 1, 2014. Retrieved fromhttp://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf