What are The Different Insurance Metal Levels??

Health insurance is confusing for everyone and understanding what your looking at can be frustrating. This Blog is going to help break down one area of insurance that we see, metal levels in Michigan!

It's important to note that these levels only apply to those who are not offered benefits through work, medicare, or medicaid!

The key difference of the plans is the amount you pay to the amount the insurance company pays, which is called cost sharing. However, it does not stop there.  One other key note is that all plans will cover the 1

10 essential health benefits.

1. Ambulatory Patient Services: Outpatient care (Dr Visits) without hospital admissions
2. Er Services: Needing immediate attention
3. Hospitalization: Inpatient care including surgery & overnights
4. Maternity and Newborn care: Prenatal, childbirth, postnatal
5. Mental Health & Substance Use: Behavioral health, counseling and psychological
6. Prescriptions
7. Rehabilitation & Habilitative Services: This includes devices and services to regain or develop skills after injury or illness
8. Laboratory
9. Preventative & Wellness & Chronic Disease Management Screenings, immunizations, diet counseling, managing conditions like diabetes.
10. Pediatric Services: Caring for children that includes dental and vision.

So let's look at Bronze first! 

Bronze is intended for individuals and families that are in overall good health. If you only go for normal checkups this plan might work well for you! It can offer a feeling of security if you have a something happen that causes serious illness or injury. Its easy on the budget MONTHLY! but keep in mind when receiving care you will end up paying more at that time. This is considered a high deductible health plan. One option to help with cost is considering an HSA account to use in times of need. I will make another post regarding HSA and why it is a good option for all families! 

I personally would not think this plan would be good for those with long term or life long conditions (chronic). It can cost you more compared to opting to a higher metal level.

1. Bronze: 40% to 60% (cost sharing)
   1. Lower monthly payments (premiums)
   2. Highest out-of-pocket
   3. Protection for serious injury or sickness
   4. SOME have $0 on select drugs and virtual visits
   5. NOT eligible for Cost Share Reduction
   6. Able to use premium tax credits (if qualified) to reduce or eliminate monthly payments
      
      

Let's now take a look at Silver healthcare plans! 

The silver plan is the most popular because it has the best savings and the cost is balanced a little better! When deciding whether to go with a silver plan you should ask yourself a few questions. How often are you seen? Do you have any long term/life long conditions that will cause you to visit the dr more often? The monthly payment you make (premiums) will be a bit higher but keep in mind the insurance company will then pay more for care you receive and you will pay less out of pocket! Another consideration is that the silver plans are the only ones where you are able to use both cost share reduction and advance premium tax credit. These can reduce or even eliminate the amount you ay monthly and lower your deductible. 

1. Silver 30% to 70%  (cost sharing)
   
   1. Can use CSR and APTC
   2. Balance between insurer and insured with cost sharing
   3. Only metal level plans that include unique cost-sharing opportunities to help further lower out-of-pocket costs for members who qualify.
   4. Slightly higher monthly premium
   5. Less out-of-pocket 
   6. include added enhanced benefits like $0 for commonly used prescription drugs and $0 virtual care visits.
   7. Moderate healthcare needs throughout the year

Gold plans 

Everyone loves gold!! but should you go with this option? Gold plans will bring higher monthly payments. However, if you or anyone in your family (to be covered) have a chronic condition and find yourself at the Dr often should consider this metal level. Gold plans will reduce the amount you pay out of pocket & lower your deductibles. Another consideration for the gold planis if you have a large family with dependents. This can help manage the budget better by having a consistent monthly bill that reduces cost at the time of service.The network of providers is much larger. 

1. Gold 20% to 80%
   1. Greater level of coverage
   2. Higher monthly premiums
   3. Increased percentage of costs is covered by the insurance company.
   4. Can use APTC
   5. Lower deductible
   6. Lower out of pocket costs
      
      

Platinum Plan

These plans have the highest monthly payments with the lowest deductibles. If you face ongoing care this might be the level for you. It will help predict what you will be spending every month and place more of the financial burden on the insurance company. All though the coverage is the highest of all the levels, it does not suit those who do not have consistent care.  

1. Platinum 10% to 90% 
   
   1. Greatest level of coverage
   2.  Highest premium
   3. Lowest deductible
   4. Lowest Out of Pocket
   5. Insurance company takes on the majority of the cost
   6. Is better for predicting budget

That is the basic run down of the metal levels! I hope that this made it easier to understand.  

Feel free to contact me for further help with your insurance needs. I partner with the best major insurance companies so I can find the best rates you need!