What’s with health insurance metal levels? Is going for the bronze the winning choice?
When you buy health insurance, you can choose from four categories called “metal levels”—Bronze, Silver, Gold or Platinum.
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These have nothing to do with the quality of care. Instead, the differences are based on how much each plan will pay for covered costs, compared to what you’ll pay. It works like this: Bronze levels have the lowest sticker price, or monthly premium, but the highest out-of-pocket cost to you when you need care. Meanwhile, you’ll pay more up front for Silver, Gold and Platinum, but you’ll pay less when you need care.
And keep in mind there’s a fifth choice—Catastrophic plans with low premiums and very high out-of-pocket costs protect those under 30 or those with a financial hardship exemption against the costs of a serious injury or illness.
If you’re expecting to have a healthy year, it might seem Bronze is the way to go. But not so fast.
Depending on your household’s income, you could get premium tax credits or cost-sharing reductions through Maine’s online health insurance marketplace, CoverME.gov. If you qualify, you can use those to help offset the higher price of a Silver plan—while having lower out-of-pocket costs and leaving more money in your pocket at the end of the year. (If you think you can only afford a Catastrophic plan, it’s worth comparing whether Bronze or Silver is a better value if you quality for premium tax credits.)
How do I pick a plan level?
Think about how you (and your dependents) will use your insurance in the coming year, like this:
Silver, Gold or Platinum might be for you if:
- You have a chronic condition like asthma, diabetes, coronary artery disease or cancer
- You have a planned surgery coming up
- You often visit specialists or your primary care physician
- You are planning to have a baby or have small children
- You take expensive brand or specialty medications
Bronze might be for you if:
- You are healthy and take few expensive medications
- You only occasionally see a doctor
- You can manage the cost of a higher deductible and maximum out-of-pocket expense should you or your family have the need for more care.
- You don’t qualify for premium tax credits or cost-sharing reductions.
Importantly, ALL Community Health Options’ plans offer preventive care at no cost, 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.
While costs are important, make sure you choose coverage that fits your needs and gives you peace of mind. For information or to get help choosing a plan, call Member Services at (855) 624-6463.
Follow @communityhealthoptions on TikTok for quick tips and tricks on how to buy and use a health plan. And don’t forget to follow Community Health Options on LinkedIn, Facebook or Instagram.
Need help understanding insurance terms? Here’s a handy guide.
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