As you’ve likely seen, all health insurance plans offered now must fit into one of the four metal categories: bronze, silver, gold, and platinum. These categories are based on how you and your health plan split the costs of your healthcare.

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What do insurance metal categories mean?

These plans will directly correlate into how much you pay for your premiums and out of pocket costs:

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Metal categories have nothing to do with the quality of care. Instead categories are based upon the 10 essential benefits as is now required by the federal government.

Other items that differentiate these metal plans include: deductibles, coinsurance amounts, and maximum out of pockets. Each insurance carrier has the ability to create plans that fall into each of the metal tiers, as long as they meet all the guidelines set forth by the Federal Government.

So what are the “10 Essential Health Benefits”?

Health plans must cover the following types of service:

  1. Preventive Care and Wellness Services
  2. Lab Tests
  3. Dental and Vision care for children under the age of 18
  4. Prescription Drugs
  5. Emergency Care
  6. Inpatient Hospitalization
  7. Outpatient care, including chronic disease management
  8. Pregnancy and Newborn Care
  9. Rehabilitation Services and Devices
  10. Mental Health and Substance Abuse Services

What are Cost Share Reductions?

Cost Share Reductions is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance.

If you qualify, this can mean extra savings and overall out-of-pocket costs associated with having a health plan. However, these cost share reductions are only available on silver metal level plans.

To see if you qualify, click here and complete the steps. You will then be notified if you qualify for the cost-sharing reduction.