Under Obamacare (also known as Affordable Care Act), health insurers must categorize their plans into four groups – Bronze, Silver, Gold and Platinum.
Silver plans typically provide the greatest value. This is due to their lower monthly premiums and moderate care costs when needed, plus qualifying for cost-sharing reduction subsidies.
Bronze
Bronze plans may offer lower premiums than other plan levels, but may incur higher healthcare expenses as you access treatment. If your income qualifies for cost-sharing reduction subsidies, silver or gold plans might be more suitable choices.
The Affordable Care Act’s metal tier designations make comparing plan benefits easier; however, keep in mind that each plan’s specific benefit design and network may have an enormous effect on both health care needs and costs.
Your monthly payment and deductible depend on a plan’s metal tier, determined by its overall actuarial value (the percentage of costs the insurance company will cover). Bronze plans offer lower premiums but often carry high out-of-pocket expenses once your deductible has been met; depending on your annual income you may qualify for premium subsidies or Obamacare tax credits to make them more manageable.
Silver
Silver plans are ideal for individuals whose income falls between 200% of FPL and the Federal Poverty Level, as they qualify for Premium Tax Credits and Cost Sharing Reduction subsidies. Furthermore, many Silver plans can also be combined with an HSA to gain tax advantages.
However, since the discontinuance of CSRs, insurers have increasingly been “overpricing” enrollees within this income bracket – prompting them to switch away from Silver plans that fit them more closely towards non-Silver ones with cost sharing levels that may not meet their needs; this phenomenon is known as silver loading.
As such, we suggest shopping around and selecting a higher metal tier plan (or even Bronze) if your income will allow it to avoid exceeding the minimum annual out-of-pocket limit. Otherwise, marketplace Silver plans tend to provide sufficient flexibility, since income levels fluctuate throughout the year and cost-sharing and premium tax credits can be easily adjusted accordingly.
Gold
Gold plans offer lower out-of-pocket costs than silver and bronze plans, covering on average 80% of covered healthcare expenses while members pay 20% through copays and coinsurance payments.
If your income falls within certain guidelines, a cost-sharing reduction subsidy may be available to reduce cost-sharing amounts (deductibles and copays) when using insurance to visit doctors or receive prescription drugs. Gold plans typically offer these cost-sharing reductions so if eligible they should be your top pick.
However, intuitive pricing guidelines such as bronze plans being the least costly, silver plans providing better value than gold plans, and platinum plans being more costly have not held true in recent years. This is likely due to CSR costs being added into silver plan premiums in many areas, making gold plans cheaper in these markets than silver plans.
Platinum
The platinum Obamacare plan offers the highest level of individual market coverage available today, making it suitable for people with higher healthcare costs that can afford monthly premiums. While out-of-pocket costs tend to be lower compared to other plans, their deductible and maximum out-of-pocket amounts tend to still remain relatively high.
The Affordable Care Act has divided health insurance plans into four metal levels or “tiers,” each offering different healthcare benefits and out-of-pocket costs; bronze and silver plans typically offer less costly out-of-pocket expenses while gold and platinum plans tend to incur greater out-of-pocket expenses.
Selecting an Obamacare plan that meets your unique needs can be challenging, depending on personal factors such as medical needs and risk tolerance. At eHealth we can assist in helping find you a suitable plan to meet these criteria.
