When picking out the perfect insurance plan for yourself, it’s a unique experience shopping in the marketplace. We are here to help clear up some confusion, and help you pick what’s best! 
Going into the insurance marketplace on your own can be a daunting and frustrating experience. Having to choose insurance because your employer doesn’t offer it or you’re self-employed is a difficult position to be in. The language used, the websites you need to use to go searching, the small print, and all of this talk about gold, silver, and bronze plans, is a lot. Who knew there would be medals involved in all of this? Of course, after searching through pages and pages of plans, you will deserve a gold medal. But, does that mean a gold plan is right for you? In this blog, we will be breaking down what each of these metal tiers means, and how each could affect your choice in healthcare plans.
Due to the Affordable Care Act, every tier between gold, silver, and bronze has to cover a certain percentage of the health care cost you and your family will have every year. Just like in the real world, gold will cost more than silver, and silver will cost more than bronze. When it comes down to brass tacks, bronze-level plans will cover about 60% of your health care cost, silver will cover about 70%, and gold will cover about 80%. These percentages are how much your insurance company will pay, and the remaining cost is what you’ll be left paying out of pocket. The only exception to this is the silver plan. Depending on your income, you could be eligible for a cost-sharing reduction subsidy. This financial help provides assistance to pay for your insurance. It’s not a loan, you won’t have to pay it back. This could give you the option of three more different percentages of what your health insurance would pay and what you would be left paying out of pocket. The insurance company, in this situation, could be paying for 73%, 87%, or 94% of your insurance costs. Thanks to this subsidy, you would be getting a more expensive plan on a much bigger discounted rate. Outside of your standard gold, silver, and bronze tier plans, there is also the option of platinum tier insurance. This is the most expensive tier of all. But, your insurance company will be paying for 90% of your insurance costs and you’ll be left with that remaining 10%.
This tier is the best option if you’re looking for the lowest monthly payment, and for health care at the lowest cost. This is a good plan for someone who is only looking to protect themselves in case of a serious emergency or sickness. A lot of routine checkups are covered under all tiers, but this might not be the case with bronze level insurance. You could be facing the biggest copay expense, too. The potential of paying thousands of dollars before hitting your deductible is very high. It will end up costing you the most when you require care.
Within this tier, it is more likely that almost all of your routine checkups and appointments will be covered, and your copay will not be as high as a bronze tier. It is an excellent plan if you qualify for a subsidy. This will allow you to pay very little out of pocket while still maintaining a higher level of coverage. If you qualify for a subsidy, you have to apply for a silver plan. The cost you’ll pay before your deductible is hit will also be smaller than a bronze tier. If you’re not eligible for any kind of subsidy but can afford to pay more out of pocket, this is an excellent choice for you.
This plan is perfect for an individual who needs a lot of care on top of yearly routine visits. You will be paying a much higher bill every month for this coverage, but the out of pocket expense for when you need care will be very low. The amount you’ll have to pay before you hit your deductible will also be very low.
This is the highest monthly payment out of each of these insurance tiers. On the bright side, it is the lowest out of pocket you’ll be paying when you need care and to hit your deductible. If you need a lot of care every year, and you can pay more every month, then this is a perfect plan for you.
No matter what tier you pick for you and your family, there is a limit on how much you will be paying out of pocket before you hit your deductible. It is $8,200 for an individual plan and $16,400 for a family plan. Bronze, of course, will have the highest limit and platinum will have the smallest. The platinum tier might seem like a huge monthly expense, but in the long run, it will end up costing you less when you need care. As we mentioned above, Silver Plans can be used by those who qualify for financial subsidies. Bronze plans can be combined with HSA’s, but before choosing a bronze-level plan, make sure the plan you’re choosing allows this combination. Surprisingly, as frustrating as it can be, these tiers were created to help narrow down your search. Please remember too, that regardless of what tier you pick, that doesn’t represent the quality of care you’ll receive.
We can’t forget about copays! This is how much you’ll be paying out of pocket when you go for certain health care, including routine care visits. Bronze plans will have the highest copay, while Platinum will be the smallest. Coinsurance is also something you need to remember. Even after you hit your insurance deductible, that doesn’t mean you no longer have to pay for anything. You will still have to pay a percentage, albeit a small one, of your medical bills.
There are so many options out there, and even if you are looking at this as a daunting task because you can’t afford health insurance, there are options out there to help you. Don’t go without insurance because you think you have to. At the end of the day, even if you’re paying a small amount out of pocket, it can make the biggest difference! We hope this information helps, and when the marketplace opens up again, you’ll be able to handle it confidently! Don’t hesitate to reach out and chat with us if you have any questions. Remember, stay safe friends! We will see you next time!