You only need to know four words – Platinum, Gold, Silver and Bronze.
As of January 1, 2014, all new health plans are named after four precious metals – Platinum, Gold, Silver and Bronze. Your basic decision is to choose the metal plan that best fits your needs and budget. If you choose a Bronze plan, it’s important to know that each company’s Bronze plan will be nearly identical. The same holds for Silver, Gold and Platinum.
How do you determine which “Metal Plan” is best for you? The charts below will help make insurance easy and understandable by presenting a side-by-side comparison of benefits.
If you understand the plan benefits, it will be easier to choose the metal level right for you and your family.
THE METAL PLANS |
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| PLATINUM | GOLD | SILVER | BRONZE | BRONZE HSA | Catastrophic | |
| Actuarial Value | 90% | 80% | 70% | 60% | 60% | 60% |
| Premium | $$$$ | $$$ | $$ | $ | $ | $ |
| Deductible | $0 | $0 | $2,000 | $5,000 | $4,500 | $6,350 |
| Coinsurance or Cost-sharing |
10% | 20% | 20% | 30% | 40% | 0% |
| Max OOP IND Family (2+) |
$4,000 $8,000 |
$6,350 $12,700 |
$6,350 $12,700 |
$6,350 $12,700 |
$6,350 $12,700 |
$6,350 $12,700 |
| Preventive | $0 | $0 | $0 | $0 | $0 | $0 |
| Office copay | $20/40/40 | $30/50/60 | $45/65/90 | $60 (3) | 40% | $0/$0 (3) |
| Lab | $20 | $30 | $45 | 30%>Ded | 40%>Ded | 0% |
| X-ray | $40 | $50 | $65 | 30%>Ded | 40%>Ded | 0% |
| Emergency | $150 | $250 | $250 | $300 | 40%>Ded | 0% |
| Generic RX | $5 | $19 | $19 | $19 | 40%>Ded | 0% |
| Brand RX | $15/25/10% | $50/70/20% | $50/70/20% | $50/75/30% | 40%>Ded | >Ded |
| Brand deduct. | $0 | $0 | $250 | >Calendar | 40%>Ded | $6,350 |
”>Ded” means after deductible
Office copay: general/specialist/urgent care
Brand RX: preferred/non-preferred/specialty
The Metal Plans Described
The Platinum plan is the “top-of-the-line” health plan that pays around 90% of all medical bills. Of course, if it provides the best benefits, it will also be the most expensive.
This plan features low copays for doctor visits ($20 copay for primary care doctor) and prescription drugs ($15 for preferred brand medications). With a zero deductible, you only pay 10% of the negotiated fees for larger medical services up to a maximum of $4,000. This plan is ideal for someone with an ongoing medical condition that requires multiple ongoing prescriptions, doctor visits, laboratory tests, and a greater risk of hospitalization.
The Gold plan is the “second best plan” after the Platinum plan that pays around 80% of medical bills. This is a great plan for people with ongoing medical conditions, but who want premiums that are lower than the Platinum plan.
This plan features low copays for doctor visits ($30 copay for primary care doctor) and prescription drugs ($30 for preferred brand medications). As with the Platinum plan, there is a zero deductible; you then pay 20% of larger medical expenses up to a maximum of $6,350. Like all health plans, one annual exam is included at no cost to you.
The Silver plan is the “middle-of-the-road” plan that pays around 70% of medical bills. The $2,000 deductible falls between the zero deductible of the Platinum and Gold plans and the $5,000 deductible of the Bronze plans.
The Silver plan is the lowest cost plan with copays for both doctors ($45 copay for primary care doctor) and prescription drugs ($50 copay for preferred brand medications). In addition, you get annual exams at no cost to you. For larger medical expenses, upon meeting the $2,000 deductible, you pay 30% of remaining bills up to the $6,350 out-of-pocket maximum.
The Bronze plan is the “most affordable” health plan and pays around 60% of medical bills. The primary focus of this plan is to provide protection from large, unexpected medical bills. After meeting the $5,000 deductible, you pay 30% of the remaining bills up to the $6,350 out of pocket maximum. Like all health plans, you get an annual exam at no cost to you.
The Bronze plan is the most affordable plan on the market because it only has copays for the first three office visits to a primary care doctor and all prescriptions count towards the plan deductible of $5,000. If you are looking for the lowest cost plan, this plan or the Bronze HSA plan are the best options.
The Bronze HSA is a great option for people who:
- Prefer to buy health insurance which provides coverage for large, unexpected medical bills, and
- Would like to save tax-free money in a health savings account to pay for routine and expected medical services.
Contributions to health savings accounts are tax deductible on Federal Tax forms. This plan is ideal for people who want to save for medical expenses in the future including retirement.
More information on HSA-based plans can be found here.
This plan pays around 60% of medical bills, and is only available to individuals under age 30 –commonly known as a, “Young Invincible.”
A Young Invincible doesn’t visit the doctor very often, but does need protection from large, unexpected medical bills. This plan has a $6,350 deductible, which is also the out-of-pocket maximum. All medical expenses count toward that $6,350 except for three free office visits to a primary care doctor and one free annual exam.
A Young Invincible doesn’t visit the doctor very often, but does need protection from large, unexpected medical bills. This plan has a $6,350 deductible, which is also the out-of-pocket maximum. All medical expenses count toward that $6,350 except for three free office visits to a primary care doctor and one free annual exam.