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Health Insurance Metals Explained

Oct 05, 2021
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As we move from the summer to the winter Olympics, it seems only fitting to talk about bronze, silver, and gold. Like the Olympic metals, types of health insurance plans are categorized into metal levels. Unlike Olympic metal categories, health insurance metals have nothing to do with quality or performance. Rather, health insurance metals help people understand the amount of cost-sharing that goes on between the plan holder and the insurance company in any given plan. (Need a refresher on what cost sharing means? Check out our health insurance lingo blog post here!) 

Remember that the exact amount of cost-sharing can vary from plan to plan. According to healthcare.gov, at each metal level, you’ll pay a different percentage of total yearly costs of your care, and your insurance company will pay the rest. Total costs include premiums, deductibles, and out-of-pocket costs like co-payments and co-insurance.

As a rule, the less the insurance company pays in cost-sharing, the lower the cost of the plan. So, Bronze plans typically have the lowest monthly premium costs and highest costs when you need care. Monthly premium costs generally increase according to metal levels. Silver, Gold, and Platinum cost more each month in premium payments but will have lowers costs when you need care. While your monthly premium price is often the top consideration when purchasing health insurance, it’s important to consider the deductible and cost-sharing as well, since these two factors can impact the total amount of out-of-pocket healthcare costs you might incur in a plan year. The total cost of care is what really matters.

When choosing a plan, you’ll want to think about how much you (and your dependents) are likely to use your insurance coverage. Consider things like how often you see a doctor, what medications you take, and whether you foresee scheduling any elective surgery during the year to come. If you think you’ll use your healthcare plan frequently or have prescription medications you take regularly, you might want to consider a higher metal level that offers lower deductibles and makes your costs easier to predict (like a Gold or Platinum plan). If you don’t expect needing many healthcare services, a lower-premium/higher cost-share plan might be a better fit.

One thing that’s important to know is that ALL Health Options’ plans in ALL metal categories offer $0 cost-share preventive care, including yearly wellness checks. Many plans also offer an array of low-to-no-cost benefits that help offset many healthcare expenses (like wellness visits, prescription benefits, and vaccines), even for people with chronic conditions. All non-HSA plans offer Amwell® urgent care telehealth visits with $0 cost-sharing. So, whether you go for the Gold, qualify for Silver, or choose any of the other plan options, having healthcare insurance is extremely valuable in adding to your quality of life and peace of mind.

SEE ALSO

Maine Insurance Superintendent Eric Cioppa, in a recent press release, urged Mainers who don't have health insurance to buy coverage during the extended Open Enrollment that is running now through August 15, 2021. 

[Note: On March 23, this special enrollment opportunity was extended until August 15, 2021. This action will allow individuals and families more time to access the SEP and enroll in Marketplace coverage with the increased tax credits to reduce their premiums and for those currently enrolled to change plans in response to the increased tax credit availability.]

Cioppa said, "If you thought that you can't afford to buy health insurance, it's a good idea to take another look. Plans have changed, some rates have gone down this year, and depending on any changes to your income and household size, you may qualify for more assistance than in the past."

His good news came with some words of caution: "Mainers should be sure to use trustworthy sources to get the best healthcare coverage at the best price," Cioppa said. "We've received complaints from consumers who purchased plans they thought provided comprehensive coverage, but that actually have very limited benefits."

We are proud that Cioppa cites Community Health Options as one of only three trustworthy sources of comprehensive health insurance providers in Maine. To earn this distinction, we must provide broad coverage for office visits, lab work, emergency room visits, hospitalizations, and medications, and we are required by law to pay for a certain percentage of our Members’ medical costs.

Cioppa urges Maine people to beware of any organization offering health insurance that makes you feel pressured to buy or asks for financial information or a Social Security number over the phone. Always read plan materials carefully.

When in doubt, check with coverme.gov or call Health Options’ Member Services at (855) 624-6463 Monday through Friday 8:00 a.m. to 6:00 p.m.