Levels of Health Coverage
The Metal Levels
The way health plans are structured will change in 2014 under the Affordable Care Act. The goal is to make it easier for individuals and small businesses to compare coverage options and tradeoffs, all while expanding access to coverage.
Effective 2014, all nongrandfathered individual and small group health plans will be organized in four levels of coverage: bronze, silver, gold, and platinum.
The levels are based on actuarial value calculations They define the split between what the consumer pays and what the health plan pays. As the metal category increases in value, so does the percent of medical expenses that health plans cover.
Higher percentage of expenses paid by the plan equals lower monthly premium payment.
| Category | Paid by health plan | Paid by individual |
|---|---|---|
| Platinum | 90% | 10% |
| Gold | 80% | 20% |
| Silver | 70% | 30% |
| Bronze | 60% | 40% |
In addition, all carriers who offer a metal level health plan – both the Individual marketplace and the Small Business Health Options Program (SHOP) – are required to offer child-only plans in that level.
Carriers may offer a catastrophic-only policy to young adults (under age 30) and other individuals who are exempt from the ACA’s individual responsibility (generally, individuals who would experience a hardship purchasing coverage). The catastrophic-only policy is available in the individual market only.