Metal Plan Levels in the Health Insurance Marketplace
You're ready to make decisions about health insurance. Let's review the plans that insurance companies and HMOs will offer in the Health Insurance Marketplace, where you can go online to compare the different plans.
Standard plans offering four levels of benefits will be available--Bronze, Silver, Gold and Platinum. These are called "metal levels." Catastrophic plans are also 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 compare "apples to apples" when choosing a health insurance plan. Each metal level represents a different level of coverage. Your out-of-pocket expenses (i.e., the amount you may be required to pay for covered services due to deductibles, coinsurance or co-payments) are greatest under the Bronze level plan and the least under the Platinum level plan.
For example, a Bronze level plan provides the least coverage; you pay 40% of the cost of covered services and the insurance company or HMO pays 60%. But it is the least expensive. For someone who expects to use fewer health care services, a Bronze level plan with lower monthly premiums may be a good option.
A Platinum level plan provides the richest coverage. The insurer/HMO pays 90% of the cost of covered services and you pay 10%. But the Platinum level plan is also the most expensive. It may be a great option for someone who needs more frequent care.
Silver level plans provide a higher level of coverage than Bronze level plans. Gold level plans provide a higher level of coverage than Silver level plans.
With each higher level of coverage, the premium is more expensive. However, under all of the metal level plans, your annual out-of-pocket expenses cannot exceed $6,350 for individual coverage or $12,700 for family coverage. (During the first year of coverage only, some plans may have a separate out-of-pocket maximum for medical and pharmacy benefits, each subject to these limits.)
*On average, the plan will pay this percentage of the total cost of the policy’s benefits
Health insurance companies and HMOs can offer various metal level plans. Plans may be purchased directly from Cigna. In addition, Cigna plans are available for purchase through your state's Health Insurance Marketplace in Arizona, Colorado, Florida, Tennessee and Texas.
Here are some things to keep in mind as you choose the right plan for your needs:
The higher the level of benefits that a plan offers, the higher the premium. Bronze level plans will have the lowest 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 provides coverage for the same minimum essential health benefits and under all metal level plans in-network preventive care services (for example, mammograms, colon cancer and diabetes screenings) are 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 for years. Now all insurance carriers will be offering them as well.
This is a fixed flat fee for a health service or a medication. Most plans will include copays and the amounts will vary.
Deductibles and coinsurance
Deductibles and coinsurance will vary even among plans in the same metal level. For example, two Gold level plans may have the same annual out-of-pocket maximum, but different deductible and coinsurance requirements. Read the benefit descriptions closely so you'll 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 anticipate your expected 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 will have lower monthly premiums, if you receive lots 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 in 2014, 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 will get a sliding-scale reduction in out-of-pocket costs—copays, deductibles, coinsurance—from the federal government.
You need to enroll in a Silver plan to get this reduction in out-of-pocket expenses.
Keep in mind, Silver level plans provide a level of coverage for the same essential health benefits as every other metal level plan. Cigna's Silver level plans offer many choices in deductible and coinsurance levels. These options help keep health insurance affordable for you.
The premium tax subsidies and cost-sharing reductions are only available to you if you purchase coverage through a Health Insurance Marketplace. You are not eligible for premium subsidies or cost-sharing reductions if you are eligible for Medicare, Medicaid or coverage under an employer-sponsored plan that is affordable and provides minimum value or covered under an employer sponsored plan regardless of whether it is affordable or provides minimum value.
Making your decision
The Health Insurance Marketplace will make it easier to compare the plans available in your state. Or, you can review plans on Cigna.com. If you have more questions, contact Cigna's licensed insurance agents at 1.877.683.2268, 8:00 am to 10:00 pm ET, Monday through Friday.
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