Cost sharing refers to the portion you will have to pay (or “share”) for covered services, at least until you reach the annual maximum out-of-pocket (or “MOOP”) limit. The following are types of cost sharing:
Metal Levels
For major medical coverage, the ACA has created standardized levels of coverage into “metal levels” — Bronze, Silver, Gold and Platinum. The levels are meant to more easily compare plans. In general, plans with lower cost-sharing will have higher premiums, and plans with lower premiums will have higher cost-sharing.
|
Plan Level |
Actuarial Value - This is the estimated % of total costs your insurance plan will pay for covered services |
Your Expected Cost Share – The amount of covered services you will have to pay |
|---|---|---|
|
Gold |
80% |
20%, up to maximum OOP |
|
Silver |
70% |
30%, up to maximum OOP |
|
Bronze |
60% |
40%, up to maximum OOP |
|
Catastrophic |
Not applicable |
100% up to maximum OOP |
If you are purchasing on the Individual Market, don’t assume that purchasing a plan with a lower premium will cost you less money.
- If you qualify for a tax credit, the credit will reduce the amount of premium you have to pay.
- If you qualify for a tax credit and purchase a Silver plan, you may also qualify for cost-sharing assistance (in the form of lower co-pays, co-insurance and deductibles), which could make buying a Silver plan less expensive than buying a Bronze or Catastrophic plan.
- Whether you receive tax credits or not, if you know you are going to need medical services on a regular basis, purchasing a plan with a lower cost-sharing (such as a Gold plan) could cost you less, even with a higher monthly premium, because the insurance company will start paying a larger portion of your bills sooner.
Note: Catastrophic plans are only available to individuals age 30 and younger, or to those who qualify for a hardship exemption.