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Understanding how the different health insurance tiers work.
The "metal tiers" for health insurance plans are categories that represent how the cost of health care services are split between you and your health insurance company. Metal tiers do not describe the quality of service you'll receive.
All health insurance plans split the cost of your health care services between you and your insurer. Here's the percentage of your health care services that you can expect to pay broken down by metal tiers:
|Metal Tier||Consumer Pays||Insurer Pays|
Note that these percentages do not represent a coinsurance – instead, these percentages are based on a combination of deductibles, copayments, and coinsurance, as dictated by the specific structure of the plan. These percentages do not take premiums into account. Also, these values don't represent the exact amount you will pay for medical services. They are simply a benchmark based on average cost sharing amounts for all participants in the plan.
Generally, Bronze plans have the lowest monthly premiums, while Platinum plans have the highest monthly premiums. However, as you can see from the cost-sharing breakdown, Bronze plans have more out-of-pocket costs, like higher deductibles, than Platinum plans.
Bronze plans will typically have higher out-of-pocket limits (the amount you pay out of pocket before your health insurance company starts paying 100% of your healthcare costs). Note that all plans need to adhere to the maximum out-of-pocket limit as set by the federal government ($7,900 for individual plans and $15,800 for family plans in 2017).
When shopping for health insurance plans, make sure you take this cost-split into account when comparing plans. If you rarely go to the doctor, a Bronze plan may make sense for you. If you frequently visit the doctor, however, a Bronze plan may not make sense – you may be paying a lower premium, but you'll be paying more out-of-pocket.
If you qualify, a health insurance premium subsidy may help you afford a plan in a higher tier, ultimately saving you money across the board.
(You may also qualify for a "catastrophic" plan, a special type of health insurance plan that has a very high deductible. Catastrophic plans are only available for people under 30 or people with a hardship exemption. You cannot use a subsidy on catastrophic plan premiums.)
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
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