What are the Metal Levels in Marketplace Insurance?
- December 19, 2019
- by Health Sherpa
When you start planning for Open Enrollment, your first question may be which metal level of health coverage is right for you. Health insurance plans in the Marketplace fall into four metal-level tiers: Platinum, Gold, Silver, and Bronze. These metal levels reflect the differences in how costs for your healthcare are split between you and your insurance company. Generally speaking, plans with higher premiums have lower annual deductibles. And plans with lower monthly premiums tend to come with high deductibles. Depending on the amount of medical costs you end up with in a year, different metal levels will offer different kinds of value to you.
The different metal tiers in no way reflect a difference in the level of care you receive.
Thanks to the Affordable Care Act, all Marketplace plans must cover the following 10 categories of Essential Health Benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
No matter which plan type you select, all Marketplace plans are Qualified Health Plans. And these plans must offer a set of preventive care services – including many vaccinations, cancer screenings, and birth control – for free when you visit an in-network healthcare provider, even if you haven’t met your deductible yet.