The Affordable Care Act (ACA), also known as Obamacare, is a reform law that makes health insurance affordable. Its standardized health insurance plans ensure that individuals can access necessary healthcare services with predictable out-of-pocket costs. Administrators categorize these plans according to ACA metal levels, determined by the amount individuals pay for their insurance and how much their health insurance plan covers if they need particular services.

It is vital to understand ACA metal tiers so that you can choose a level and a corresponding health insurance plan that works for you and your family. Follow along with this short guide detailing ACA metal and learn how our qualified eHealth brokers can find health insurance that meets your needs.

What are the ACA metal levels?

Under the ACA, most new health insurance plans introduced in the marketplace must fall into the ACA metal levels. There are four ACA metal tiers: bronze, silver, gold, and platinum. The law sorts the plans into different metal tiers according to their actuarial value (AV), or the percentage a health insurance plan will pay out of total costs for a specific benefit. The lower the metal tier, the lower the monthly health insurance premiums and the higher the out-of-pocket costs. The higher the metal tier, the higher the premiums and the lower the out-of-pocket costs.

It is crucial to know that metallic levels only refer to costs shared by the individual and the plan. They do not reflect the quality of care patients receive nor determine the number of services covered by the plans. That said, every health insurance marketplace plan must include the 10 Essential Health Benefits at the minimum, including completely covered preventive care services. Higher-tier ACA metal plans often offer partial coverage for a more extensive array of services.

Additionally, the ACA dictates out-of-pocket cost limits whether an individual accesses a bronze, silver, gold, or platinum metal plan. In 2022, no plans can exceed $8,700 for an individual or $17,400 for a family. While there are caps, individuals may be able to make their health insurance plans even more affordable through benefits, such as premium tax credits or cost-sharing subsidies. Individuals must meet specific requirements to qualify for these further cost reductions.

Bronze

Bronze is the lowest ACA metal tier, meaning bronze health insurance plans offer the lowest monthly premiums. Yet, when individuals need health or medical services, they must pay higher out-of-pocket costs than other metal levels. Likewise, they typically have higher deductibles before the plan offers any coverage. On average, the individual pays 40% of the services, while the bronze plan pays 60%.

Silver

Silver plans are one step above bronze plans on the health insurance marketplace. While the monthly premiums are affordable, the deductibles and out-of-pocket costs are slightly lower. When someone needs care, they will pay around 30% of the expenses, while the plan covers 70%.

Silver level plans are the only ACA metal tiers that consider cost-sharing reductions. People eligible for cost-sharing subsidies can apply their benefits to their health insurance plan. Depending on their income and family size, they can reduce their total costs significantly, which will reflect automatically in their plan’s out-of-pocket maximum.

Gold

Gold is one of the ACA metal premium tiers of ACA. Gold plans have high premiums but maintain low out-of-pocket costs for healthcare services or treatments. They will also have low deductibles so that individuals can access their coverage quickly. Average coverage is 80% from the health insurance plan, while individuals must pay 20%.

Platinum

Platinum is the highest of the ACA metal levels. Platinum plans have the highest monthly premiums but the lowest out-of-pocket costs and deductibles. This type of health insurance plan covers 90% of medical expenses, and individuals only need to pay 10%.

What are catastrophic health plans?

ACA organizes all healthcare plans to fit into the four metal levels. However, catastrophic health insurance plans are exceptions to the rule. These plans do offer some coverage for essential services and 100% coverage for preventative care. However, people chose them for their emergency coverage. This way, they can help certain individuals avoid incredibly high costs during accidents, conditions, or illnesses.

Catastrophic health plans have very low monthly premiums. In most cases, they fall below those of the bronze metal tier. However, there is a high annual deductible. Furthermore, for most healthcare services, individuals must pay high out-of-pocket costs. However, in the case of emergency intensive care, people have a level of protection against high out-of-pocket costs.

Unlike the ACA metal plans, people must meet specific requirements to qualify for the catastrophic health plan. They can receive an insurance plan in this category if they are under 30 years of age and have an affordability or hardship exemption. In other words, if they had personal or financial circumstances preventing them from affording another health insurance plan.

VIDEO: What do Metallic Benefit Levels Mean?

Metallic health plan levels chosen by eHealth customers 

The graphic below shows the percentage of metallic plan levels chosen by eHealth customers.

Cost of health plans according to metallic levels 

eHealth’s 2017 Index Report
Plan’s Metallic Level	Average Premium for Individual Plan	Average Deductible for Individual Plan	Average Premium for Family Plan	Average Deductible for Family Plan
Catastrophic	$173	$7,148	$367	$14,292
Bronze	$374	$5,953	$903	$12,044
Silver	$418	$2,758	$1,061	$5,424
Gold	$502	$778	$1,252	$1,835
Platinum	$575	$37	$1,472	$140

How do I know which ACA metal plan is right for me?

Now that you have an excellent understanding of ACA metal tiers, it is time to match a metal plan with your specific needs. It is crucial to assess your current health, regular healthcare or medical services, and financial situation to choose the best plan.

In general, a lower-tier plan such as a bronze plan is a good choice if:

• You are in good health.
• You do not require regular healthcare provider visits or healthcare services.
• You want to protect yourself in a worst-case scenario.
• You do not have a high income and are looking for low monthly premiums.

Often, people need help choosing between a bronze and a silver health insurance plan. Apart from the higher health insurance coverage, silver plans are also excellent if you qualify for cost-sharing reductions. It can help individuals who need frequent healthcare services receive significant savings.

The premium gold plans and platinum plans are excellent choices if:

• You require regular healthcare provider visits or healthcare services.
• You would like to access your coverage sooner.
• You do not mind paying high monthly premiums.

If you are experiencing extraordinary personal or financial circumstances which prevent you from paying for any of the ACA metal plans, a catastrophic health plan may be the perfect fit. It can help protect you against exuberant medical costs in the case of an emergency or accident.

Choose a health plan with eHealth

Thanks to the Affordable Care Act (ACA), more than 35 million Americans receive health insurance coverage. With the introduction of ACA metal levels, bronze through platinum, it is now easier to find affordable health insurance plans and access essential medical services at lower costs. However, it is still important to find one that meets your specific healthcare and medical needs and considers your income and expenses. It is also crucial to consider personal situations, allowing you to access certain benefits such as premium tax credits, cost-sharing subsidies, or catastrophic health insurance.

If you are ready to find the health insurance plan that is right for you, contact one of our eHealth licensed insurance agents today. We can help you find an individual or family insurance plan with coverage for necessary services, excellent monthly premiums, and acceptable out-of-pocket costs and deductibles. Contact us today to discover your options. 

Related Articles

• Major Medical Health Insurance Plans
• Understanding Obamacare
• Qualified Health Plans
• Catastrophic Health Insurance
• ACA Subsidies, or Obamacare Subsidies