Choice Stories

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

The amount you pay in premium depends on what percentage of covered benefits are paid for by the health insurance carrier. For example, a Platinum plan is typically more expensive, but pays a higher percentage toward covered in-network services. On the other hand, a Bronze plan typically offers lower premiums, and it pays less toward covered in-network services. Costs could be higher in the long term for individuals with a Bronze plan who need a lot of medical care. For small business, group-sponsored health insurance, you (as the employer) select the metal tier to offer to your employees. Some programs, such as the CaliforniaChoice small group private exchange, give you the option to select more than one metal tier. Contact a CaliforniaChoice broker if you want to know more about the ACA metal tiers.