November 23, 2020
Understanding the ACA Metal Tiers
Understanding Health Insurance ACA Metal Tiers
The Affordable Care Act (ACA) introduced four metal tier levels of coverage based on the actuarial value for each health plan. The categories have nothing to do with the quality of care provided by the health insurance carrier, but instead represent the share of in-network expenses paid by the health insurance carrier and the percentage of costs paid by the member – you, your employees, or dependents.So What Are The ACA Metal Tiers?
Metal Tier | Payment Based on Actuarial Value (Within +/- 2%) | Member Pays |
Platinum | Insurance carrier pays 90% of the costs of covered in-network benefits | 10% of costs of covered in-network benefits |
Gold | Insurance carrier pays 80% of the costs of covered in-network benefits | 20% of costs of covered in-network benefits |
Silver | Insurance carrier pays 70% of the costs of covered in-network benefits | 30% of costs of covered in-network benefits |
Bronze | Insurance carrier pays 60% of the costs of covered in-network benefits | 40% of costs of covered in-network benefits |