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Whether you shop on or away from your state’s Obamacare exchange, you will select a qualified health insurance from one of four “metal levels”: bronze, silver, gold and platinum.
Obamacare’s metal levels can help streamline your health insurance shopping experience by making it easy to narrow your options. Especially when it comes to reducing your overall Obamacare cost, sorting through Marketplace plans by metal level can help you easily determine which plan fits with your budget and needs.
Differences Between Metal Plans
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. 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.
The average percentage of covered healthcare expenses by metal plan breaks down as follows:
- Bronze and Expanded Bronze
- Insurance Company Pays: 60%
- You Pay: 40%
- Insurance Company Pays: 70%
- You Pay: 30%
- Insurance Company Pays: 80%
- You Pay: 20%
- Insurance Company Pays: 90%
- You Pay: 10%
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.
Obamacare Cost: Bronze (Lowest Monthly Premium) to Platinum (Highest Monthly Premium)
Your Obamacare cost will largely be determined by the type of metal plan you purchase. Consider your healthcare budget and specific healthcare needs (as well as the healthcare needs of any family members who will be covered by the plan), and determine the best metal level that corresponds.
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 2016, the percentage of Obamacare exchange enrollees by metal level broke down as follows:
- Bronze – 22%
- Silver – 70%
- Gold – 6%
- Platinum – 2%
- Catastrophic – 1%
Are Metal Plans Only Available on the Marketplace?
Not all companies will offer all metal levels. All plan types (if not every plan) 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.