And the Winners Are…
Have you ever wondered why insurance policies are labeled bronze, silver, gold, or platinum? What do these designations mean? Am I about to win a trophy? Or…?
Wonder no more. Jeff Hess, Empower Brokerage’s individual, group, and ancillary health expert, explains why insurances are labeled as different metal rankings in the video below.
Metal Plans
Insurance plans are broken down into five separate categories. There are bronze, silver, gold, platinum, and catastrophic plans available for purchase.
The bronze plan is the lowest level of coverage for the smallest amount of money (lowest premium). Jeff claims that bronze plans have “what they call an actuarial value of 60%,” which means, in theory, that the insurance company would pay for 60% of your healthcare, and you would be responsible for the other 40% (speaking in simplified terms). After you pay your premium or per-month charge, that is.
The silver plan is the next ladder wrung up from a bronze plan, offering slightly more robust coverage at a little higher cost: “a 70% actuarial value of coverage.” You’d be solely responsible for 30% of your healthcare coverage with a silver plan.
Gold plans have 80% actuarial value, so you would be only responsible for 20% of the costs beyond your premium. Most people under age 65 will opt for bronze or silver plans for the lower premiums, but gold plans are considered excellent coverage for those willing to spend a little more money a month to keep themselves well-covered.
Platinum plans operate at a 90% actuarial value. People who own platinum policies will pay much more money each month than bronze, silver, or gold plan owners. But, when using their policy (co-pays, prescriptions, in-office visits, co-insurance rates, etc.), they will pay very little, if anything.
Catastrophic Plans
Catastrophic plans are among the cheapest plans on the market. However, it has a lot of strings, even more so than the others. Typically, to qualify for a catastrophic plan, you can’t be older than 30, and/or you must have experienced some verifiable hardship. The Healthcare.gov website lists the qualifying hardships, but we recommend double-checking with a licensed insurance professional before applying for catastrophic coverage as criteria may have changed or are changing.
Conclusion
You’ll hear a lot of insurance talk about bronze, silver, gold, and platinum—remember, these metal tiers are just a way to identify good, better, best, and awesome coverage. Ultimately, the precious metals designate a scale of available plans and provide an easy metric for insurance professionals and consumers alike to understand.
Have Health Insurance Questions?
We hope that this information on ACA metal plans is helpful for you.
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This article was updated 3/19/24.
Are there ANY PLANS that are just easy to understand, cover the needs of the individuals , and ,basically, non mind boggling , And straight to the darn point? Example….. My fiancee, works everyday, as a roofer, and is starting to have COPD,and asthma like symptoms. Ok, no,problem. I’ve had to take him to emergency room a few times. Get prescription,etc.. ARE THERE ANY PLANS THAT WORK HERE? I don’t care if it’s 300 to 400 $$ a month, BUT, IF HE NEEDS CARE OR HOSPITALIZATION, THEN SO BE IT. IS THAT TOO MUCH TO ADK FOR?
Michele, yes there are plans that are relatively easy to understand. You do have time to decide or change coverage, so I would recommend having our agents shop for you and explain it all to you in layman’s terms. The ACA plans are simple enough, if explained by someone who has studied them. Your Fiancé may need to get an accident plan, coupled with a marketplace plan to cover preexisting conditions. Short-term medical won’t cover preexisting, nor would most hospital plans. But an accident plan would cover him if he has an accident on the job and the marketplace plans would cover his treatment regardless of whether he has it before coverage begins. Call our agents and let them see what’s best and have them explain it to you. Even if you chose something already, have them shop and give you their advice. We care about our clients and hope you have a happy marriage and a Merry Christmas. Call us at (844) 410-1320 to get in touch with one of our agents. I’m sure we can give you some options.