When it comes to health insurance plans, choosing between the tiers of the plan can certainly be confusing. After the passing of the Affordable Care Act, and the implementation of the Healthcare Marketplace, plans have begun to be much more standardized. That means that you can compare them more easily, and that’s exactly why the marketplace has the bronze, silver, gold and platinum plans set up. In order for a health insurance plan to qualify for the marketplace, they must have plans that fit into these categories. However, regardless of what the specifics of the plans are within the marketplace, they all cover what are known as essential services.
These services including things like emergency services and hospitalization, prescription drugs, physical therapy, maternity care, mental health services, treatment for chronic diseases, ambulatory services, addiction treatment and more. The four tiers of the plans on the marketplace – the four metallic levels – are separated based upon what is known as actuarial value; the more healthcare costs that are paid for by the plan; the higher the actuarial value. As you might imagine, the higher the actuarial value, the higher the premium is going to be every month. Let’s look at each of these plan categories individually.
There isn’t much you can do to accurately predict unexpected medical expenses, but there are a few factors that can give you a clue. If you think that there is a good chance that you will be needing a lot of medical services over the next year then you may want to go with the platinum plan which offers the most out of the four metallic levels when it comes to the percentage of medical bills that are paid as well as the percentage of medical procedures and services that are covered. Of course, this assumes that you are able to afford the higher monthly payment that comes along with choosing the platinum plan. For many people, a premium that high simply will not fit into the budget.
The Gold Plan is the plan that is the slightly lower tier than the platinum one. The gold plan still offers a significant portion of medical expenses paid, but the premium isn’t quite as high. This is a good plan for people that know that they are going to have slightly above average medical appointments and services, but also know there is a chance of getting really sick at some point throughout the year. The premium for this plan level is usually a little bit more manageable than the one for the platinum level, and you want to look at the plan carefully to make sure that nothing vital is missing from the description.
Silver is another option you have. Silver is basically the middle ground between the lowest level plan and the platinum one. The silver level is usually a pretty affordable plan for just about any family. However, it also means that you’re going to have a higher deductible and that if an emergency happens to your family at some point throughout the year then you may not receive reimbursement or a benefit safety net. However, this is probably the most common plan that families choose. You still have plenty of protection and your premium is going to be manageable no matter what your budget.
The Bronze Plan is for those that consider themselves extremely healthy and think it is unlikely that they will need anything medical related over the next year. The bronze plans basically only offer the bare minimum that you will need to stay healthy. If there is truly a medical emergency and you have tens of thousands of dollars hospital bills, you are going to have to meet a pretty large deductible before the insurance company will pay for your medical expenses. Bronze does have the disadvantage of making you ineligible for the cost sharing reduction subsidy, which is the tax credit that all marketplace users have access to if their income falls below the federal poverty line.
The Bottom Line
The bottom line is there is a lot to look at and determine before you can choose from any of these four metallic plans. It is also worth noting that most plans out there do not offer all four of these, but instead offer either two out of the four or three of the four. You should know what you are looking for before you go into the marketplace, but seeing a side-by-side with the categories can certainly be helpful in filtering them down so that you can have the best one for your family. There is definitely a lot to take in, but there is no doubt that the marketplace has made plans easier to compare and helped families make better decisions regarding their health insurance.