Healthcare Metal Plans at a Glance


Healthcare Metal Plans At A Glance

Open enrollment to purchase ACA-compliant healthcare plans for next year ends January 31, 2016. That sounds like plenty of time but, between now and then, you’ve got the Christmas and New Year’s holidays, the NFL playoffs and a life. By law, you have to have qualified healthcare coverage or pay a fine. To help you decide which healthcare metal plan is best for you, here’s a guide to the plans at a glance.

Bronze, Silver, Gold or Platinum?

Plans in each of the four metal levels cover different percentages of an average person’s healthcare costs including premiums, deductibles, copays, coinsurance and out-of-pocket expenses. What you actually pay will depend on the services you actually use during the year.

  • Bronze level plans pay an average of 60%, you pay about 40%
  • Silver level plans pay 70% on average, you pay about 30%
  • Gold level plans pay 80% on average, you pay about 20%
  • Platinum level plans pay an average of 90%, you pay about 10%

To look at it another way:  the higher the metal level, the higher your monthly premium and the lower your actual out-of-pocket costs.

Costs versus Benefits

Under the ACA, all qualifying plans MUST offer the same 10 basic benefits. But any of the plans can choose to offer you more than the bare minimum. That’s why it’s important to compare plans before you buy.

What’s the Right Metal Plan for You?

If you’re healthy, a Bronze plan might make the most sense. If you have chronic health conditions, a higher level metal will help you contain out-of-pocket costs. Keep in mind, however, that ACA caps what any plan can charge you for out-of-pocket. And no qualifying plan can turn you down because of a preexisting condition.

Where’s the Best Place to Buy Your Plan?

If you want to apply for government subsidies or tax credits that are based on your income, you’ll have to purchase a Silver plan from a government exchange: either your state’s exchange  if it has one, or the federal Otherwise, you can buy directly from any private insurance provider who offers individual and family plans, which, depending on where you live, may give you more plans to choose from. You can make comparisons and shop online for healthcare metal plans for individuals here.

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