Metal Level Comparison

Beginning in 2014, health plans will be required to offer health insurance that meets certain levels of coverage. The coverage levels are based upon the actuarial value of the plan and are represented by metal levels: Bronze, Silver, Gold or Platinum. These values indicate the percentage of total average costs for covered benefits that a plan will cover.


  Bronze Silver Gold Platinum
Covered Benefits 60% of Essential Health Benefits 70% of Essential Health Benefits 80% of Essential Health Benefits 90% of Essential Health Benefits
Preventive Services
Co-insurance
Cost to you for health services
You will be responsible for approximately 40% of all covered benefits up to your out-of-pocket limit. You will be responsible for approximately 30% of all covered benefits up to your out-of-pocket limit. You will be responsible for approximately 20% of all covered benefits up to your out-of-pocket limit. You will be responsible for approximately 10% of all covered benefits up to your out-of-pocket limit.
You will not need to pay any portion for preventive services if you receive them from a provider within your plan’s network. You will also 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.
Cost-share subsidy eligible?
Lower co-pays and other out-of-pocket expenses.
No. This plan is not eligible for cost-share subsidies that could lower your out-of-pocket expenses. Yes. If your income is between 100% and 250% of the Federal Poverty Level, with this plan you may be eligible for cost-share subsidies to lower the cost of health services.* No. This plan is not eligible for cost-share subsidies that could lower your out-of-pocket expenses. No. This plan is not eligible for cost-share subsidies that could lower your out-of-pocket expenses.
Premium subsidy eligible?
Lower cost premium.
Yes. 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 are not eligible for a premium subsidy if you are eligible for affordable, minimum value employer-sponsored coverage.
Protect your finances Protect your finances in the event of the unexpected. Learn more about supplemental insurance: aflac.com/individuals/policies.aspx

* If receiving cost-share, a higher actuarial level plan is automatically assigned to you based on your income to lower the cost to you.

Definitions and/or 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 and 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 so 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

Note: This chart has been shortened for your optimal online experience. Click download the article to download the full PDF.

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