Metal Plan Levels in the Health Insurance Marketplace
You're ready to make decisions about health insurance. Let's review the plans that are offered in the Health Insurance Marketplace.
Cigna health plans available on the Marketplace offer three levels of coverage Bronze, Silver, Gold. These are called "metal levels." Platinum level plans are also available on the Marketplace, but they are not offered by Cigna. In addition, catastrophic plans are available, but they do not meet the minimum requirements of the Affordable Care Act and are available only to those granted hardship exemptions and to those under age 30.
The "metal levels" were created to help people understand how much they will pay versus how much the plan pays.
Plans in each category pay different amounts of the total costs of an average person's care. This takes into account the plans monthly premium, deductible, copayments, coinsurance, and out-of-pocket maximum. The actual percentage they will pay in total or per service will depend on the services they use during the year.
- Bronze: Your health plan pays 60% on average. You pay about 40%.
- Silver: Your health plan pays 70% on average. You pay about 30%.
- Gold: Your health plan pays 80% on average. You pay about 20%.
- Platinum: Your health plan pays 90% on average. You pay about 10%.
The higher the level of benefits that a plan offers, the higher the monthly premium. Bronze level plans have the lowest monthly premiums and Platinum level plans the highest. Generally, the more you pay in monthly premiums, the more the plan pays toward your health care costs when you receive health care services.
Analyze all the numbers closely when comparing plans. The metal levels will help you compare them more easily.
Although the coverage levels differ by metal level, each metal level plan covers the same essential health benefits including in-network preventive care services (for example, annual check-ups, routine mammogram, and diabetes screenings) covered at 100%*.
You'll also have access to inpatient care, urgent care, emergency care, pediatric services, rehabilitation and therapies. Cigna customers have had most of these benefits included in their plans for years. Now all insurance carriers include the same set of essential health benefits in their individual health plans.
This is a fixed flat fee you pay toward health services such as doctor visits or prescriptions. Most plans will include copays and the amounts will vary.
Annual Deductibles and coinsurance
An annual deductible is the amount you pay each year before the Cigna plan begins to pay for covered services. In-network coinsurance is the amount you pay for covered medical services after you have satisfied the annual deductible. If your plan includes out-of-network benefits, out-of-network coinsurance is the amount you pay for covered medical services after you have satisfied the annual out-of-network deductible. You may pay more if the provider’s charges exceed the amount Cigna reimburses for billed services.
Deductibles and coinsurance will vary even among plans in the same metal level. For example, two Gold level plans will have the same annual out-of-pocket maximum, but different deductible and coinsurance requirements. Read the benefit description on your plan documents closely to understand what you will be required to pay when you receive medical care.
Balancing premiums with out-of-pocket costs
In choosing the metal level plan that's right for you, it's important to consider your anticipated health care needs so that you can balance your premium and out-of-pocket costs when you need care. For example, while Bronze and Silver level plans have lower monthly premiums, if you receive a lot of covered services in a year, the higher out-of-pocket expenses may make the Bronze or Silver level plans more expensive than a Gold or Platinum level plan.
Think carefully about the medical expenses you had during the past year and what you expect during the upcoming year. This will help you make your choice.
Financial assistance and the metal plans
Low and moderate income individuals and families may qualify for premium tax credits and cost-sharing reductions. If you qualify for a tax credit, it can be used to reduce the premium you have to pay for any metal level plan, but cannot be used to reduce your premium for a catastrophic plan. If you qualify for a cost-sharing subsidy, you can save money on out-of-pocket costs with reduced copays, deductibles and coinsurance.
You need to enroll in a Silver plan on the Marketplace to get this reduction in out-of-pocket expenses.
Keep in mind, Silver level plans cover the same essential health benefits as every other metal level plan. Cigna's Silver level plans offer choices in deductible and coinsurance levels. These options were designed so that you can choose the plan that's right for you.
The premium tax subsidies and cost-sharing reductions are only available to you if you purchase a Health Insurance Marketplace plan.
If you have Medicaid or Children’s Health Insurance Program (CHIP) coverage, you and/or your children are considered covered under the health care law.
*Some preventive care services may not be covered, including most immunizations for travel. Refer to your policy for a complete listing of covered and non-covered services
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