Compare new health
plan metal levels

Gold, silver and bronze are familiar when it comes to the Olympic Games. But did you know that when it comes to health insurance, gold, silver and bronze take on a different meaning? Beginning in 2014, health plans for individuals and small groups are required to offer health insurance that meets certain levels of coverage represented by metal levels.

These values show the percentage of the total average costs for covered benefits that a plan will cover, and were designed to help individuals better understand their benefits. Use the chart below to learn more about and compare each of the plan levels.

  Covered Benefits Co-insurance Risk Cost Example
Bronze 60% of Essential Health Benefits You’ll be responsible for approximately 40% of all covered benefits up to your out-of-pocket limit. This plan offers the minimal level of health protection in the event you experience an illness or injury. You’ll not need to pay for preventive services, but you’ll need to plan for a very high amount of financial risk and out-of-pocket costs.

The cost to you – after the deductible for an unexpected accident or illness could be*:

  • Broken leg: $4,000
  • Heart attack: $26,000
Silver 70% of Essential Health Benefits You’ll be responsible for approximately 30% of all covered benefits up to your out-of-pocket limit. This plan offers the benchmark level of health protection. It’s still a lower amount of coverage than the average employer-provided coverage. You’ll not need to pay for preventive services, but you’ll need to plan for a high amount of financial risk and out-of-pocket costs.

The cost to you – after the deductible for an unexpected accident or illness could be*:

  • Broken leg: $3,000
  • Heart attack: $19,500
Gold 80% of Essential Health Benefits You’ll be responsible for approximately 20% of all covered benefits up to your out-of-pocket limit. This plan offers coverage equivalent to the average employer-provided coverage. You’ll not need to pay for preventive services, but you’ll need to plan for a moderate amount of financial risk and out-of-pocket costs.

The cost to you – after the deductible for an unexpected accident or illness could be*:

  • Broken leg: $2,000
  • Heart attack: $13,000
Platinum 90% of Essential Health Benefits You’ll be responsible for approximately 10% of all covered benefits up to your out-of-pocket limit. This plan offers coverage above the average employer-provided coverage. You’ll not need to pay for preventive services, but you’ll need to plan for a low amount of financial risk, as well as 10% of out-of-pocket costs.

The cost to you – after the deductible for an unexpected accident or illness could be*:

  • Broken leg: $1,000
  • Heart attack: $6,500
All Plans

All plans cover preventive services with no co-insurance. You will not need to pay any portion for preventive services if you receive these services from a provider within your plan’s network.

All plans may have limits or exclusions. You will need to pay for any limits or exclusions on your benefits. These limits may include number of refills for certain drugs, number of visits to certain specialists and number of days covered for certain benefits.

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All plans may be premium subsidy eligible. If your income is between 100% - 400% of the Federal Poverty Level, you may be eligible for a premium subsidy to help lower the cost of your premium (monthly payments for health coverage). However, you’re not eligible for a premium subsidy if you’re eligible for affordable, minimum value employer-sponsored coverage. Note: Only the Silver (70%) plan is eligible for a different subsidy called a cost-share. If your income is between 100% and 250% of the Federal Poverty Level, the silver plan may be eligible for cost-share subsidies to lower the cost of health services. If receiving cost share, a higher actuarial level plan is automatically assigned to you based on your income to lower the cost to you.

*Please note that the potential out-of-pocket costs are distinct from the out-of-pocket limits set by the IRS and discussed in more detail below. The out-of-pocket costs are intended to reference potential additional expenses, such as rent or mortgage payments, child-care costs, utility bills, or transportation to and from treatment facilities.

Definitions and more information:

Essential Health Benefits
A set of health care categories that must be covered by certain plans. They include:1

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative/habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services, and chronic disease management
  10. Pediatric services, including oral and vision care

For more information visit: http://www.healthcare.gov/glossary/e/essential.html

Out-of-pocket limit
The out-of-pocket limits established by the IRS for 2014 are $6,350 for individual coverage and $12,700 for family coverage. These limits apply only to covered benefits, and if an individual or family incurs expenses for non-covered benefits, these will not count towards their out-of-pocket limit, adding to potential unexpected costs.

Preventive services
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.1 For more information visit: http://www.healthcare.gov/law/features/rights/preventive-care/index.html

Premium
The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.1

Federal poverty level
A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.1

Supplemental Insurance
Low-cost supplemental insurance such as accident, hospital, and disability insurance will pay you cash for illnesses or injuries, and will help you cover out-of-pocket costs that major medical insurance was never intended to cover.

Source:
1 healthcare.gov/glossary

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