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“Metal” plans – Bronze, Silver, Gold and Platinum

Today, health insurance companies offer many different plans for you to choose from, and the choices can be very different from company to company.  In 2014, health insurers will need to offer plans that fit into “tiers” or “levels” called Bronze, Silver, Gold, and Platinum. The idea is to make it easier for shoppers to compare options. These are often called the “metal levels” and more than one plan may be available in each level.

All plans sold in or outside of the exchange to individuals and small businesses must fit into one of the metal level categories, with one exception. Within the exchange, there is one “non-metal” plan called the “catastrophic plan.” This plan is only for people under the age of 30 or who are exempt from the requirement to purchase coverage because the premium would exceed 9% of their income. The catastrophic plan will only available through the exchange, and no cost-sharing subsidies can be used for it.

As you might guess from their names, the metal levels increase in benefit value with each level. Platinum plans will offer the most generous benefits, and bronze the least. The percentages shown in the table are based on actuarial values of the average percent of essential health benefit costs covered in-network for a typical population.  The percentages do not necessarily match the actual co-insurance or co-pay amount of a specific benefit.

Metal Level

Percent of essential health benefits covered
in-network for a typical population

Bronze

60%

Silver

70%

Gold

80%

Platinum

90%

You’ll still be able to choose different deductibles within each level. Within the exchange, each health insurer participating in the exchange must offer the Oregon standard plan design in the Bronze, Silver, and Gold levels. In addition, Cover Oregon will allow health insurers to offer up to four additional plan designs in each metal level, with two of them being “innovative plans.” Innovative plans are plans that involve new approaches in wellness or health engagement. Prices cannot be different inside and outside the exchange for the same plan benefits.

The metal levels are designed to provide the same average level of benefits — it does not necessarily mean than a Silver plan from one company will be exactly the same as a Silver plan from another company. You might compare it to buying a car. Many car companies offer a four-door sedan-style car, but each car might have a slightly different look or features that make it unique. As you shop for a car, you would note the differences between each sedan and decide which one suits you best. You might prefer the one that comes with more child safety features, while another person might prefer the one with the best gas mileage.

In the case of health insurance, one Bronze plan design may have better hospital coverage, while another Bronze plan design might have better coverage for doctor’s office visits.  They both qualify as Bronze plans based on the average percent covered, (called “actuarial value”), across all benefits for a standard population. The percent of covered benefits will be different for each person, based on what benefits are actually used. Important considerations such as rates, provider network, drug formulary, customer service, and administration also vary by health insurer.

Learn More: What about dental, vision, and alternative care?

 

Oregon Information for Oregon Residents:

Healthcare Reform: The Basics

Exchange Marketplace: A New Shopping Option

New Standards for Benefits and Plan Designs

Financial Assistance for Health Insurance


Not an Oregon resident?
Click here.

Are you eligible for subsidized coverage?

Use this subsidy calculator from UC Berkeley Labor Center to get an estimate.

Are you a Medicare member?

HealthcareLawGuide.com doesn't address Medicare changes, but you can find information about Medicare and the ACA at Medicare.gov.


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