Choice Stories

February 17, 2018

CaliforniaChoice Offers Coverage in All ACA Metal Tiers

Nearly eight years ago, the Affordable Care Act (ACA) introduced the concept of “Metal Tiers” to employers and consumers looking to purchase health insurance. The Metal Tier levels – Platinum, Gold, Silver, and Bronze – help you and your employees make a more cost-conscious decision when shopping for health coverage. Each tier aligns with the benefits offered by the plans in that tier, and it’s a good way to forecast what you can expect when it comes to cost sharing when visiting the doctor or being treated at a hospital in your health plan’s provider network.

 

Here is a snapshot of the Metal Tiers:

Plan Category/ ACA Metal Tier Insurance Plan Pays You pay
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

What Metal Tier is right for you? That depends on your individual or family health care needs and budget.

 

A Bronze health plan:

  • Offers the lowest monthly premium
  • Includes higher out-of-pocket costs when you need care
  • Can have a deductible (the amount you must pay before your health plan begins to pay) of thousands of dollars annually
  • Is a good choice if want a low-cost way to protect yourself from worst-case medical scenarios (such as a serious sickness or injury)

While your monthly premium is lower with a Bronze-tier plan, your annual costs could be greater than with a different plan tier; that’s because of your deductible and the higher portion of costs you must pay for covered health care services.

 

A Silver health plan:

  • Offers a moderate monthly premium and moderate costs when you need care
  • Has a deductible that is typically lower than a Bronze-tier plan
  • Is a good choice if you are willing to pay a slightly higher monthly premium and want to have more of your routine care covered
 

A Gold health plan:

  • Has a higher monthly premium (than a Bronze- or Silver-tier plan)
  • Offers lower costs when you need care (because the plan pays a greater portion of the costs for covered services and your deductible is typically less than with a Silver or Bronze plan)
  • Is a good choice if you are willing to pay more each month to have a larger portion of your health care costs covered when you need care

If you expect to need a lot of health care, health care experts say a Gold plan can be a good value.

 

A Platinum health plan:

  • Has the highest monthly premium
  • Offers the lowest cost when you get care (because it pays the highest percentage for covered services when you seek treatment)
  • Typically has a lower deductible (the amount you must pay before your plan begins to pay)
  • Is a good plan choice if you’re willing to pay more each month to have a greater percentage of your eligible medical services covered when you seek care

All plans in all tiers include free preventative care and some offer free or discounted services for eligible care before you meet your deductible. (To read an earlier post about Understanding the ACA Metal Tiers, link here.)

People under age 30 and those of any age with a hardship exemption or affordability exemption may be eligible to purchase a fifth health plan type – a Catastrophic plan. The monthly premiums for a Catastrophic plan are usually lower, but the deductible (the amount you must pay before your health plan begins to pay) is very high -- $7,150 for 2018.

CaliforniaChoice offers plans in every Metal Tier: With CaliforniaChoice, you and your employees can choose plans in every Metal Tier. In fact, CaliforniaChoice offers a total of more than 70 HMO, PPO, EPO, and HSP (Health Care Services Plan) options, as shown in the table below.

Metal Tier HMO Plans HSP Plans EPO Plans PPO Plans
Platinum 15 0 0 0
Gold 17 1 0 4
Silver 18 1 2 2
Bronze 12 1 1 0

Here is a look at Metal Tiers and the insurers and health plans offered by CaliforniaChoice:

CaliforniaChoice Metal Tier Availability by Carrier and Plan Type
Carrier Bronze Silver Gold Platinum
Anthem Blue Cross 1 EPO 1 HMO 2 EPOs 2 PPOs 1 HMO 4 PPOs 1 HMO
Health Net 1 HSP 2 HMOs 1 HSP 2 HMOs 1 HSP 2 HMOs
Kaiser Permanente 2 HMOs 3 HMOs 2 HMOs 2 HMOs
Sharp Health Plan 3 HMOs 3 HMOs 3 HMOs 3 HMOs
Sutter Health Plus 2 HMOs 2 HMOs 2 HMOs 2 HMOs
UnitedHealthcare 2 HMOs 4 HMOs 3 HMOs 3 HMOs
Western Health Advantage 3 HMOs 3 HMOs 4 HMOs 2 HMOs
Total Options 1 EPO
1 HSP
12 HMOs
2 PPOs
2 EPOs
1 HSP
18 HMOs
4 PPOs
1 HSP
17 HMOs
15 HMOs

Note: The table listing Metal Tier availability by carrier is accurate as of January 2018, although it is subject to change. Ask your broker for the latest health plan information.

 

It’s good to remember, though, that CaliforniaChoice is much more than great health care. You and your employees also get access to valuable extras through the no-cost Business Solution Suite. It includes discount Dental, Vision, and Hearing services, a free Premium Only Plan*, online HR support from HRAnswerLink, employee discounts from Cal Perks, a free prescription drug discount card, Cal-COBRA or Federal COBRA billing (depending on how many employees you have), and a free Flexible Spending Account (for groups of 15 employees or more).

Ask your broker for more information about private exchanges and CaliforniaChoice. He or she can help you determine what amount you want to contribute to your employees’ health insurance and discuss how CaliforniaChoice offers easy administration, while giving you and your employees an easy way to find a health plan that best matches your individual or family health care needs. If you don’t already have an employee benefits broker, we can help you find a CaliforniaChoice broker to speak with about coverage for your employees.

 

*Initial case set-up is covered; fee applies after first year