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Health Insurance Metals Explained

Oct 13, 2023
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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 how these costs work? Check out our health insurance lingo blog post here!) 

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

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 Community 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 choose Bronze, Silver, Gold or Platinum, you can find a plan that meets your budget and your needs while giving you peace of mind and helping to keep you and your family healthy.

SEE ALSO

As great as New England is, we all must leave it occasionally. When we do, it’s reassuring to take great healthcare coverage along for the ride, which is why Health Options offers great plans with a national network option.

Kid in college in Santa Cruz? Cool. Regular business trips to Baltimore? No problem. Family cabin on Lake Champlain? Go you! Congratulations on making a wise choice on your healthcare options. Having a plan that travels with you across the country means you’re free to roam - and take your accident-prone teenager with you – no worries.

Community Health Options provides national in-network coverage through First Health®, a nationwide preferred provider organization (PPO) of hospitals, doctors, and other health care providers. This network includes approximately 6,100 hospitals, 130,000 ancillary facilities and 845,000 doctors and other health care providers. By choosing from this list of in-network providers when you travel, you can lower your total cost of care.

Having a national network is one thing, but it’s another to know how to access it. Instead of waiting until you break your ankle on a sidewalk 600 miles from home, learn a few basics now. Use the Health First online provider search tool. It’s simple and available 24/7 and includes detailed information. 

Using your desktop or mobile device, go to https://providerlocator.firsthealth.com/mcho. Next, select a provider type from the options of Physician, Hospital, Urgent Care Center, Lab and Radiology, or All Providers and enter the ZIP code or State where you’re traveling. If you’re a nervous traveler, you may want to test this search function before you reach your destination. For example, a quick search of Urgent Care Centers within 10 miles of Beverly Hills results in 75 options.

Keep your Member card with you when you travel, remember these steps, or call First Health at 1-800-226-5116, and you’re good to go.