By Britt Olsen
Public Health – Seattle & King County
Feb 26, 2014 - Like champion Olympic athletes, each of the new health insurance plans has a metal status: bronze, silver, or gold. There are no winners or losers, no first or last place finishers, but the metal tiers help shoppers compare similar plans from different companies.
As you compare the three levels, you’ll see how the pricing differs. Even within a particular category, premiums, copayments and deductibles vary.
Broadly, here is what you can expect from the three metal groups offered in Washington state.
All plans cover ten essentials: hospitalization, preventive care, outpatient care, emergency care, laboratory services, maternity and newborn care, pediatric care, mental health and substance abuse services, rehabilitation and prescriptions.
Most Washington enrollees are choosing silver plans
The Bronze Age
Generally, you’ll pay less per month for Bronze plans, but you will have bigger out-of-pocket expenses at the time of a claim. That’s because these plans usually have a higher deductible and higher co-insurance, which is your share of each medical bill.
A Bronze plan must cover 60% of your medical expenses — meaning, if you end up needing medical care, you can expect to pay 40% yourself.
A Silver plan strikes a balance between what you pay in your monthly bill vs. how much you’d have to pay if you have substantial medical costs. Some experts consider these the best way to make the most of available subsidies and tax credits, says US News & World Report. If your income level qualifies you for some aid, this is the tier where that assistance can pay for a bigger portion of your plan.
Also, at the Silver level, some people qualify for additional subsidies that cover part of the deductible and co-payments. For these extra subsidies, according to NPR, you have to choose a silver plan, and have an income below $28,725 for an individual or $58,875 for a family of four.
Silver plans will cover 70% or more of your medical expenses.
Go for the Gold
Gold plans might be good options for individuals or families who:
visit the doctor frequently,
have ongoing prescription needs, or
want the peace of mind that any medical surprises won’t cost too much.
You’ll have higher monthly payments, but you pay less for each treatment. And there’s often a lower deductible — meaning the insurance company starts paying its share of your health expenses sooner, once you’ve paid that annual amount.
Gold plans cover at least 80% of your medical costs.
What’s most important is that you select a plan that suits your own health and financial needs. That one is the winner.