While the Affordable Care Act requires that all plans include the same minimal coverage for health care items and services in 10 essential health benefits categories, plan costs will vary depending on which metal level is selected. Consumers shop with cost-sharing in mind and determine what share of covered medical expenses they can afford.
Meet the Four Metal Levels
The metal levels and their actuarial value percentages are as follows:
Bronze plan – 60 percent of covered medical expenses paid by the plan; 40 percent by the consumer
Silver plan – 70 percent of covered medical expenses paid by the plan; 30 percent by the consumer
Gold plan – 80 percent of covered medical expenses paid by the plan; 20 percent by the consumer
Platinum plan – 90 percent of covered medical expenses paid by the plan; 10 percent by the consumer
How They Work
The higher the share of covered medical expenses paid by the plan, the lower the consumer’s out-of-pocket cost. However, this scenario also translates into a higher premium. If you are relatively healthy and do not anticipate many medical expenses, a bronze or silver plan may be the right solution. If you have health conditions that necessitate frequent care and services, you may find it advantageous to select a gold or platinum plan.
Also note that health insurance companies are not required to offer all four metal levels.