If you have no idea what heavy metal has to do with your health insurance, please, keep reading!

If you are currently enrolled in an Obamacare approved health insurance plan, which is most major medical plans, you may have noticed a word like “silver” or “gold” in your insurance details. If you currently do not have an Obamacare approved plan but will in the future, then those words will definitely come up when searching for a plan. You might think that those metal types are just there for your insurance company and serve no purpose to you. However, they are actually extremely important to you because they help you understand how much your insurance company will cover for your health care services and in turn, how much you will need to cover. Metal isn’t just a type of music anymore!

What is a Metallic Level?

Metal levels are used under Obamacare (Affordable Care Act/ACA) to indicate the actuarial value of the plan. The actuarial value simply refers to the percentage of coverage that your insurance company is responsible for paying towards your health care services. The actuarial value is important to understand, because once you know what your insurance plan will cover, you will then be able to determine the amount that you are responsible for paying.2

The functions of the metal levels are pretty straight-forward. The higher the metallic level of the plan, with platinum being the highest, the higher the percentage of costs your insurance company will cover for deductibles, copayments, and coinsurance, which will cost you less out-of-pocket. On the contrary, the lower the metallic level of the plan, with bronze being the lowest, the lower the percentage of costs your insurance company will cover for deductibles, copayments, and coinsurance, which will cost you more out-of-pocket.1

Choosing the lowest metallic level, bronze, will cover about 60% of health care service costs on average. The next level up, a silver plan, will cover about 70% of costs on average. You can see the trend here, but a gold plan will cover about 80% of costs, and finally, a platinum plan will cover around 90% of costs.1 These percentages are only applicable to you until you reach your maximum out-of-pocket for the year. So, for a bronze plan, if you get sick, you will be responsible of paying 40%, while your plan will pay 60% for covered medical expenses. Once you reach your out-of-pocket maximum, your insurance will pay for all covered expenses in full.

Metallic Level % Covered by Insurance (in the form of copayments, deductibles, and coinsurance) % Covered by You (in the form of copayments, deductibles, and coinsurance)
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

Deciding What’s Best for You

When making a decision for an insurance plan, for many people, the price of the premium is the main concern. With the tiered metallic levels, platinum has the highest premium followed by gold, then silver, and finally bronze.1 However, as the image below shows, while you pay less each month for your premium, you are going to pay more out-of-pocket when you need health care services, such as doctor visits and prescriptions.

metal arrows

Although your monthly cost is a worthy concern, you should also take into consideration how you plan to use your health insurance. If you visit the doctor continually or need regular prescriptions, paying a higher premium each month may be worth it to save money on the health services you use frequently. On the other hand, if you rarely visit the doctor and consider yourself to be exceptionally healthy, maybe it’s not worth it to you to pay for a platinum level plan. Keep in mind, though, no one ever plans on getting sick and needing to use their insurance.

Catastrophic Plans

Beware of catastrophic plans as they’re only available to those under the age of 30 or those who have a hardship exemption. Click here for more information on catastrophic insurance plans.

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Citations

  1. Marketplace insurance categories. (n.d.). Retrieved September 15, 2015, from HealthCare.gov website: https://www.healthcare.gov/choose-a-plan/plans-categories/
  2. Olivero, M. (2014, November 14). Obamacare: Which ‘metal’ tier is right for you? Retrieved from U.S. News website: https://health.usnews.com/health-news/health-insurance/articles/2014/11/14/obamacare-which-metal-tier-is-right-for-you