A Basic Explanation
Any health insurance plan you buy is going to pay a portion of your healthcare costs. But how generous will each plan be? What share of your health expenses will the insurance company cover, and what share will you have to pay out of your own pocket?
To get the answer, take a look at each plan’s metal tier.
Platinum plans are the most generous, then comes gold, then silver, then bronze.
Expert Advice About Metal Tiers
- Platinum plans offer the most coverage. On average, if you buy a platinum plan, you’ll get roughly 90 percent of your healthcare costs paid for by the health insurance company. Platinum plans also have the highest premium.
- Gold plans come next — if you buy one of these, you can expect roughly 80 percent of your healthcare costs to be paid for by insurance. Gold premiums are on the high side as well.
- Then comes silver — any plan in this tier will pay roughly 70 percent of your healthcare costs. Silver premiums are in the middle range.
- Then bronze — which will pay roughly 60 percent of your healthcare costs. Bronze premiums are on the lower end.
- Below all the metal tiers, there’s catastrophic coverage. (Any plan that pays less than 60 percent of your costs does not fit into a metal tier.) Catastrophic plans are only available to some people under 30 or those who have special hardship circumstances.
So how do you decide which metal tier is right for you?
1. Find out if you qualify for government subsidies. If you qualify for financial help in the form of cost-sharing reductions, you should consider buying a silver-tier plan. Why? Because you can only use cost-sharing reductions to help you pay for copays and coinsurance if you’ve got a silver plan. If you’re not sure whether you’re eligible for cost-sharing reductions to help you afford health insurance, do a quick estimate of your eligibility here on GetInsured, or call one of our brokers for help.
2. Remember, lower premiums mean less generous plans. If you’re tempted by low premiums, you’re not alone. Getting health insurance for the lowest possible monthly price might feel like you’re getting a bargain. Just remember that plans with lower premiums also usually have higher deductibles that you’ll have to meet, which means more out-of-pocket costs for you before your insurance kicks in. And vice versa — higher premium plans usually have lower deductibles. In other words, you may save now but end up paying more later.
3. Keep in mind that the percentages aren’t exact. We’ve just told you how much value each tier plan is supposed to provide, but you should know that the actual value you get might be lower (or higher).
That’s because the percentages are based on something called “actuarial value” — which means it’s an average. To get the actuarial value, an insurer takes the people who buy a particular type of plan and lumps them together. Then they lump together their healthcare costs. So for example, a platinum-tier insurance plan will pay about 90 percent of the healthcare costs for the whole group. Any one individual in the group might get more or less value from the plan.
4. Get a customized recommendation based on your needs. There is a way to make shopping easier so you don’t get tangled up in metal tier comparisons. Check out your unique GetInsured Plan Scores (GPS) for plans in your area. GPS scores will give you an overall apples-to-apples comparison for every plan you see, and it’ll be based on your answers about how you actually use healthcare during the year. (If you’d like help with your GPS scores, or have other questions about comparing plans, call a GetInsured broker.)