What the ACA metal levels mean, and which one is right for you

HealthMarkets helps you choose the Affordable Care Act plan that’s best for you.

Shopping for health insurance can be confusing. That’s one of the main reasons why Affordable Care Act (ACA) health plans have metal levels — bronze, silver, gold and platinum — that help offer clarity.

Before you sign up for coverage, it’s important to understand what these metal levels do and don’t mean. Here’s what you need to know.

What ACA metal levels don’t mean

If you’ve ever watched the Olympics, you know that gold is better than silver, which is better than bronze. After all, nobody ever says, “Go for the bronze.”

Similarly, if you’ve ever compared credit cards, you know that platinum cards tend to offer many more perks than gold cards. For example, you might get more rewards or extra services.

It’s not surprising that you might think ACA metal levels work the same way. But they don’t. A silver plan is not necessarily better than a bronze plan. And a platinum plan doesn’t give you luxury services that all the other plans don’t offer.

What ACA metal levels do mean

So, what do metal levels really mean? “‘Metal level’ just refers to how much insurance is covering and how much the insured is paying,” says Noor Ali, M.D. Dr. Ali is a health insurance consultant in Tampa, Florida.

Here’s the breakdown for covered services:

• Bronze: Your insurance company pays 60%, and you pay 40%.
• Silver: Your insurance company pays 70%, and you pay 30%.
• Gold: Your insurance company pays 80%, and you pay 20%.
• Platinum: Your insurance company pays 90%, and you pay 10%.

However, the above math is not an exact match. Not every medical bill will be divided up that way. Instead, it means that that’s how costs will be shared across a typical population. The fancy term is “actuarial value,” and the federal government gives insurance companies very little wiggle room to go above or below those percentages.

For example, if your plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. (However, you might be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.)

Beyond how costs are shared, there isn’t much else to compare. Whatever the metal level, the plans all offer the same essential benefits, which include:

• Doctor visits
• Hospital stays
• Prescription drugs

The only difference between the metal levels is how much you’ll pay out of pocket.

Looking for an affordable health insurance plan? Call a licensed insurance agent at (800) 827-9990 to discuss what’s available, or browse your options online today.

3 special situations you should know about

As you shop for a health plan, you may come across these 3 plans, which are meant for specific situations:

• Catastrophic health insurance: In addition to bronze, silver, gold and platinum plans, some insurance companies offer catastrophic plans. These plans are only available to people under 30 or older adults who qualify for a hardship exemption or affordability exemption. They have low monthly premiums but high deductibles. If you buy one of these plans, you won’t qualify for a premium tax credit. (Premium tax credits are discounts offered by the government on certain health care plans.)
• Expanded bronze plans: Expanded bronze plans are similar to other bronze plans, with 1 exception: They either cover or pay for at least 1 major service (other than preventive services) before the deductible or they meet the requirements to be a high-deductible health plan (HDHP). “It’s in essence more value, but what exactly that value means in terms of coverage is going to change from state to state,” Dr. Ali says.
• Cost sharing with silver plans: Based on your income, you can reduce your costs with premium tax credits and cost-sharing reductions. (The latter are discounts offered by the government that lower your copays and coinsurance.) You can qualify for premium tax credits at any metal level. To qualify for cost-sharing reductions, however, you must choose a silver plan. (There are also different rules for Native Americans and Alaska Natives.)

Other factors to consider about ACA insurance

There are 2 other important factors you’ll want to consider when shopping for an ACA plan: your premium and your deductible. The premium is your monthly insurance bill. The deductible is how much you must pay before your plan pays. (This may not apply to no-cost preventive services that are included in your plan. The same is true of any other services that may come at no additional cost to you or are discounted before you meet your deductible.)

In general, bronze plans have the lowest monthly bills and the highest deductibles. Platinum plans have the highest monthly bills and the lowest deductibles. Silver and gold plans fall somewhere in between.

If you’re healthy and don’t usually need a lot of medical care, a bronze plan may be a good choice. You’ll be responsible for paying for most routine care yourself, but you’ll have coverage in case you have an unexpected — and costly — health crisis.

But if you have major health problems and know you’ll need a lot of medical care, a platinum plan might be right for you. Although you’ll pay a higher monthly bill, your out-of-pocket costs will be lower.

How to choose a health plan

So, what health plan should you choose? You’ll want to let the metal levels guide your decision. Dr. Ali shares her advice: “In my opinion, shopping by the deductible is always going to be the more-value way to shop for an insurance plan,” she says. “The lower the deductible, the more you’re getting out of the plan, the more your insurance company is covering, and the less is coming out of your pocket.”

Dr. Ali recommends shopping for a plan based on your deductible, then by metal level and, finally, by what fits your budget. In other words, metal level is important, but it’s just part of the equation.

Of course, if you simply want to go for the platinum level, that’s all right too. Just know that your insurance card probably won’t look as flashy as an actual platinum credit card.

Thinking about a metal plan? Call a licensed insurance agent at (800) 827-9990 to discuss what level is best for you, or browse your options online today.