Coverage Levels/Metal Tiers
The theory behind labeling all health plans as metal tiers: Bronze, Silver, Gold and Platinum was to try and make it simple for the consumer (you and I) to understand and create some uniformity and consistency when evaluating a health insurance plan (see charts below).
Although it is supposed to be simpler there are still many little differences that can be found in various health plans that could best be explained by an insurance agent. Contact an agent before making a decision and ask questions so you can make a wise and knowledgeable choice. Remember, this advice will not change the cost of the plan you choose so it is like having a free consultation every time you talk to your agent/broker.
You should always choose a health insurance plan according to your personal situation and needs:
- All plans offer essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care), and include certain preventive services at no cost.
- The most affordable level generally offers lower premiums but higher copayments, coinsurance, and deductibles. The other levels generally have higher premiums but lower deductibles, coinsurance, and copays.
As mentioned above, there are four primary levels of coverage: Bronze, Silver, Gold and Platinum.
Plans in the higher metal tiers have higher monthly premiums, but you pay less when you need medical care. If you choose to pay a lower monthly premium, then you will pay more when you need medical care. You can choose the level of coverage that best meets your health needs and budget.
Below are a couple of charts to help explain:
The breakdown of costs that you pay (dark shading) and costs the plan pays (lighter shading) for the standard Bronze, Silver, Gold and Platinum tiers is shown below.
- Bronze: On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent.
- Silver: On average, your health plan pays 70 percent of your medical expenses, and you pay 30 percent.
- Gold: On average, your health plan pays 80 percent of your medical expenses, and you pay 20 percent.
- Platinum: On average, your health plan pays 90 percent of your medical expenses, and you pay 10 percent.
How you and your plan share total costs of care
|
Plan Category |
The insurance company pays |
You pay |
|
Bronze |
60% |
40% |
|
Silver |
70% |
30% |
|
Gold |
80% |
20% |
|
Platinum |
90% |
10% |
Please feel free to respond to this post with questions and comments so we can better serve you.
Dan Fortier is a Wellness and Benefits Specialist at Fortier Insurance Services. Dan helps individuals and small business optimize their health and wellbeing one small step at a time. He can be reached at dan@myhealthinbalance.com