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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

 

At-home COVID-19 tests (also referred to as self-tests or over-the-counter tests) are a key measure to protect you and others from spreading the COVID-19 virus. These tests can be taken at home or anywhere, are simple to use, and provide rapid results. You can use at-home tests whether or not you have symptoms, and regardless of vaccination status.

We are pleased to announce that through an agreement with our pharmacy benefit manager, Express Scripts® (ESI), you may now order at-home COVID-19 tests via phone, online or through your local pharmacy counter at no cost to you.  Each Member on your policy may obtain up to eight (8) free at-home COVID-19 tests every 30 days. Reimbursement instructions and FAQs may be found here

The federal government also offers four (4) free at-home COVID-19 tests through COVIDtests.gov. The tests ordered on the COVIDtests.gov site do not count towards your total allotment allowed through Health Options.  

We remind and encourage you to do the following to protect yourself, your family, and community from COVID-19 spread and sickness:

  • Get vaccinated
  • Get a booster
  • Get tested
  • Stay home if you are sick
  • Wear a well-fitting mask
  • Gather outdoors or in an area with good ventilation
  • Avoid crowded settings
  • Wash your hands often