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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

You are cordially invited to join Health Options' 2021 Annual Member Meeting on Thursday, November 18, from 4:30 – 6:00 p.m. via Zoom's online meeting platform.

Use this Health Options' 2021 Annual Member Meeting link to register and get the login details at Eventbrite.

    • If using the Zoom login page, enter webinar ID number 928 6857 5459 and passcode 743788
    • Attendees may also join by phone at (646) 876-9923. Enter webinar ID 928 6857 5459 and passcode 743788.

Our 2021 meeting will cover Health Options' year in review, including fiscal updates, grant activity, improvements to plans and procedures, and the 2022 Board of Directors’ election results. We will be joined by two speakers: Tym Rourke, senior director at Third Horizon Strategies and former director at the New Hampshire Charitable Foundation, and Leslie Clark, executive director of Portland Recovery Community Center (PRCC).

Tym and Leslie will discuss “The Other Epidemic: Escalating Substance Use Disorders in Maine and Beyond.” As the pandemic continues, it’s more important than ever to devote state, federal, and community-based resources to removing barriers to care and improving substance use treatment. Tym and Leslie will discuss their experiences working to provide greater access to prevention, treatment, and recovery services.

For questions about the meeting, contact Health Options Member Services, Monday through Friday, 8:00 a.m. – 6:00 p.m., at (855) 624-6463.

And remember to let your voice be heard! All Health Options Members 18 years and older are eligible to vote in our board of directors’ election. Candidate biographies and voting instructions have already reached you by email or traditional mail. Voting ends November 5, 2021.