The Four Metal Levels, Bronze 60, Silver 70 (Enhanced Silver 73, 87, 94), Gold 80 & Platinum 90
are based on Expected Claims Payment – actuarial value (AV). This is one way (Scroll down to Standard Benefit Designs) Health Care Reform hopes to make shopping and comparing easier. So, if you get a lower priced plan with less or fewer benefits, co-pays, deductibles you simply pay more when you have a claim. Don’t worry, there is a stop loss – maximum out of pocket OOP, of say $7k so that you won’t break the bank. All plans cover the 10 essential benefits.
|What are the four metal levels?||Understanding Health Care Costs||How to find plan that fits budget|
Our video on what plan to take if you know you will have a BIG surgery or expense coming up
|View our webpage on OOP Maximum Out of Pocket|
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What are Covered California standard benefit designs?
Health insurance plans must follow Covered California’s standard benefit designs. With standardized benefits, consumers can accurately compare health insurance plans, because the benefits are the same for all plans offered in the Covered California marketplace. Additionally, standardizing benefits ensures that the selected health insurance plans define what the consumers get and limit the consumer’s out-of-pocket costs by type of service.
There is also a Catastrophic level, (high deductible) that one can qualify for, if they are under 30 or the premium is unaffordable as being more than 8% of income. Open Congress.org Blue Cross Blue Shield Blue Shield Catastrophic plan Email us for rates. [email protected]
AB 639 (Chaptered) would Prohibit any [Insurance] product from being offered other than those with a standardized product design [metal level] in the family market. Sounds like what we have with Medi Gap policies. Get the most recent status at http://leginfo.legislature.ca.gov/
I agree it will stifle innovation, so do you want same o same o or to be able to get a plan that fits your needs. On the other hand isn’t it just a mathematical calculation to see what the actuarial value and essential benefits is? Get a FREE quote for Medical Coverage. Term Life Insurance
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When you appoint us as Covered CA agent we can assist, advise and research for you, at NO ADDITIONAL charge. Here’s the instructions.
Resources & Links
One chart for Metal Levels and Enhanced Silver Cost Share Reductions
CMS said it will enforce the Affordable Care Act’s cap on annual out-of-pocket health care spending for individuals, regardless of whether consumers have an individual or family health plan. the rule capped maximum out-of-pocket costs at $6,850 for individual plans and $13,700 for family plans annually. Learn More⇒ Our Rx Page ♦ Modern Health Care 9.15.2015 ♦ Final Market Rules 45 CFR Parts 144, 147, 153, 154, 155, 156 and 158
Bronze – Co Insurance after Deductible?
Covering Costs of High Deductible Plan?
More detail on Metal Tiers (Covered CA Agent Training)
Child & Related Pages
- §156.140 CFR Metal Levels
- Catastrophic – Minimum Coverage Plan
- Claim Payment by Metal Level
- Mirrored Plans – Must offer same plan in and out of Covered CA
- Silver Plan – No Subsidies – Get out of Covered CA – Go direct
- zHistorical Metal Levels