Health ReformPolicy & LawPublic Health

The Four “Metal Plans” of Health Insurance Exchanges

1 Mins read

Summary: What are metal plans? What distinguishes one from another? When do they go into effect?HIE metal plans

Summary: What are metal plans? What distinguishes one from another? When do they go into effect?HIE metal plans

Metal plans are the levels of plans that will be included in the health insurance exchanges. Health insurance exchanges are basically marketplaces designing for purchasing insurance. They are called metal plans because each level is a different metal: platinum, gold, silver, and bronze and were created as a result of the Affordable Care Act. The idea for the metal plans originated in Massachusetts. 

Open enrollment for the exchanges begins October 1, 2013 and coverage will be effective January 1, 2014. While each metal plan offers the same essential benefits, they will vary based upon premiums and out of pocket expenses. Out of pocket expenses include deductibles, copayments and coinsurance.

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health services
  • Substance use disorder services
  • Prescription drug coverage
  • Rehabilitative and habilitative services and devices
  • Preventative and wellness services
  • Pediatric Services

Metal planshealth insurance exchange

Platinum

  • Lowest out of pocket for enrollees – approximately 10%
  • Highest premiums

Gold

  • Out of pocket expenses – approximately 20%
  • Must be offered by an insurance company in order to participate in the exchanges

Silver

  • Out of pocket expenses – approximately 30%
  • Must be offered by an insurance company in order to participate in the exchanges
  • The standard plan in terms of tax credit eligibility

Bronze

  • Highest out of pocket expenses – approximately 40%
  • Lowest premiums

Within each of the different levels, premiums will vary depending upon which company insurance is purchased through. This is where the term health reform informationmarketplace comes into play. Consumers will have to shop around to find the plan that will best suit their needs in terms of out of pocket expenses, premiums charged, and whether their doctors are part of the particular network. Additionally, for those that opt not to have health insurance, there will be penalties assessed.  For 2014, the penalty will be the greater of $95 or 1% of adjusted annual household income. The penalties are expected to become steeper in later years.

Plans are beginning to release their premium schedules. They will vary from state to state. More detailed information will be released over the coming months so it will be important to remain current on the exchanges for your individual state.

Related posts
Global HealthcarePolicy & Law

Do HMOs Deserve A Bad Reputation? The Truth Of Managed Healthcare

3 Mins read
Have you ever heard people say that HMO health insurance is no good? It’s no secret that HMOs have a bad reputation,…
Policy & Law

Top 4 Important Things To Understand About Insurance

2 Mins read
When it comes to Medicare, the enrollment process can be a little tricky. That’s why it’s important to understand the relevant health…
Health carePolicy & Law

Elmiron Controversy Highlights Need For Longterm Clinical Drug Testing

4 Mins read
Elmiron has recently been the subject of a number of lawsuits brought about over claims that the drug causes vision problems and may lead…