Bronze. Silver. Gold. Platinum.
During Obamacare’s Open Enrollment Period, it may feel as though you’re competing in some form of health insurance Olympics. But these aren’t medals to be won—they are levels of health insurance plans that offer varying levels of coverage costs. These “metallic” tiers are the foundation of the Affordable Care Act’s structure.
What Is the ACA? And Who Needs Insurance?
The U.S. Congress passed the Affordable Care Act (ACA) in 2010. It intended to reduce healthcare costs and increase the affordability and quality of health insurance for all Americans. During Open Enrollment—which is November 1, 2015, through January 31, 2016—Americans can either keep their current plan or shop for another plan during this period. People who do not enroll in a health insurance plan or have a coverage gap face a penalty that will be paid when they file their annual taxes.
All Obamacare plans found through the federal exchange and other marketplaces are assigned a metallic level name indicating the level at which you and your insurance company split coverage of healthcare costs. Regardless of coverage level, all plans cover the same list of essential benefits, such as maternity, mental health, preventive, and pediatric dental care, and more.
There are four standard metallic levels:
- Bronze Plans pay 60% of covered medical expenses up to the plan’s out-of-pocket maximum, and you pay 40% through deductibles, copays, and coinsurance. Bronze plans typically have the lowest monthly premiums but have the highest out-of-pocket expenses.
- Silver Plans pay 70% of cover medical expenses up to the plan’s out-of-pocket maximum, and you pay 30%. Silver plans are the only metallic level plans where Americans may qualify for cost-sharing reductions and subsidies based on income level.
- Gold Plans pay 80% of covered medical expenses up to the plan’s out-of-pocket maximum, and you pay 20%.
- Platinum Plans pay 90% of covered medical expenses up to the plan’s out-of-pocket maximum, and you pay 10%. While Platinum level plans have the highest premiums, they have the lowest out-of-pocket costs.
How to Choose a Coverage Level
If you’re wondering what level is best for you or your family’s needs, think of a few factors. You should consider:
- How often you go to the doctor or hospital
- If you need regular, frequent care or infrequent care only a few times a year
- Prescriptions you take
- Whether your preferred doctor or hospital is in-network of the plan you are considering
Osborne Insurance Services is a local health insurance agency based in Raleigh, NC, and will help you shop insurance companies to find the best fit for you. When you contact us, we’ll put you in touch with a knowledgeable agent who will help you through the process of finding a plan right for your needs. Contact us online for a free custom quote, or call us today at (919) 845-9955 or 1 (877) 777-7844.