Platinum. Gold. Silver. Bronze. If surfers of the Health Insurance Marketplace didn’t know any better, they’d think they were shopping for an Olympic medal! And they just might deserve a medal for trying to navigate the Marketplace at all.
However, that’s not what these Platinum, Gold, Silver and Bronze terms are about. These “metallic” levels are meant to help shoppers determine how much they will pay in out-of-pocket health care costs once their insurance provider has footed its end of the bill.
Before we delve into how the different levels work and what each offers, though, it’s important to first understand that, no matter which metal level you select, your coverage will always include 100 percent of the 10 essential health benefits.
While any plan on the Marketplace may choose to offer extra coverage, no plan can offer less, as the EHBs are the minimum requirements for all Marketplace health care plans. Additionally, in order to participate in the Marketplace, insurance companies must offer both Silver and Gold plans at the very least.
Alright, now that the groundwork has been covered, let’s break down the “worth” of each metal:
As you’ve probably put together by now, each level has a value. In the health care world, this is known as the “actuarial value”—the average percentage of health care expenses that will be covered by the insurance provider. Gold and Platinum plans have the higher actuarial values, and the people with these plans will have much lower out of pocket costs because of it. However, the disadvantage to plans with higher actuarial values is that the premiums will be much higher each month. Each level’s actuarial values are as follows:
What you will pay will vary depending on…
- Your age
- Whether you smoke
- How many individuals will be on your plan
- The insurance company
You might find yourself with a large deductible but with low coinsurance rates. Or you might get a low deductible with high coinsurance rates. What you can count on, though, is for your price to increase as the actuarial value of your chosen plan goes up. However, beginning in 2014, you can rest assured that you’ll never pay more than $6,350 in out-of-pocket costs as an individual, and no more than $12,700 for the entire family.
Which Plan Is Best for You?
This is tricky to answer, as it all depends on your health care needs and your current financial situation. If you are sick a lot and go through quite a few prescriptions, you should consider a Gold or Platinum plan. Yes, you’ll pay a higher monthly premium, but a higher percentage of the overall costs will be covered.
However, if you’re relatively healthy and you don’t foresee any major health complications in the future, a Bronze or Silver plan may cover all of your needs. But take into consideration unforeseen accidents and illnesses as well—do you want to be covered for those, or would you rather play it by ear and hope that it’ll never come to that? That should factor into your decision as well.
Ultimately the decision comes down to two things: 1) How much you can afford to pay upfront each month, and 2) How often you visit a health care professional in the average year. When all is said and done, the amount of money coming out of your bank account will be the same in the end, no matter which level you choose.
With Gold and Platinum, your monthly premiums will be higher but you’ll pay less when you visit the doctor or get a prescription filled. With Bronze and Silver, the reverse will be true: Your monthly premiums will be lower, but you’ll pay much more when you do need to see a health care provider.
Our Better Solution
Yes, you can shop the Marketplace for varying degrees of coverage at varying prices, but in our honest opinion, no matter what plan you end up going with you will be paying too much for too little service and coverage.
At HSA for America, we understand that you have no real idea what your health care or even your financial situation will look like a month from now, much less a YEAR from now! With a health savings account, you can deposit as much money into it as you want up to $3,050 for singles and $6,150 for families. That money is tax-deferred, and you can use it to cover current and future medical expenses. Whatever money you DON’T use will roll over into the next year.
When you combine your HSA with a qualified health insurance plan, you are saving money and guaranteeing that all of your medical needs will be covered. Visit http://www.hsaforamerica.com/faq-basics.htm#a1 to see how a health savings account is the solution to your health care needs that you didn’t know you needed.
Wiley Long is President of HSA for America, and a passionate advocate for consumer-based solutions that will improve price transparency and lower health insurance and medical costs for people purchasing individual and family health insurance plans.