One of the positive aspects of the Affordable Care Act is that it gives employers the chance to offer a wide range of plans that let workers pick the coverage that’s right for them.
You can do this by offering “metallic spectrum plans,” each of which has different values and costs. Bronze, silver, gold and platinum plans are a way of serving a wide range of employee needs, budgets and concerns and reducing the potential of your healthiest employees buying more insurance than they may actually need.
While these plans are staples in the public exchanges, they are also available as group plans.
Metallic spectrum plans allow employers to stay compliant with the ACA by offering affordable coverage that covers the 10 essential benefits that are required by the health care law.
It would be wise for you to bone up on these plans as they will be the most common types available in group plan offerings in the future, experts predict.
The good thing about offering your employees choices of different metal plans is that not all of your workers have the same health care needs. If you only offer a few plans, some of your employees may be overinsured, while others may be underinsured.
For example, the most basic plans – bronze plans – have lower upfront costs in terms of premiums, but copays, co-insurance and deductibles are typically higher, compared to the top-tier plans. And the top plans, platinum, have higher upfront premiums, but lower copays, co-insurance and deductibles.
Typically, co-insurance is figured as a fixed percentage of the total charge for a service, such as 15% or 30%. Co-insurance kicks in after an enrollee has met his or her deductible. For example, assume they have already met their $2,000 deductible and the plan’s coinsurance is 15%. If the enrollee has a hospital charge of $1,000, their share of the costs would be $150.
Metal spectrum plans were spawned by the ACA, which requires that:
- Bronze plans cover 60% of an enrollee’s medical costs during the year.
- Silver plans cover 70%.
- Gold plans cover 80%.
- Platinum plans cover 90%.
Metal plans usually feature a member in-network cost-sharing maximum that is the same (currently $6,850 for individual plans), after which the insurance covers 100% of medical costs.
Deductibles and all maximums including cost sharing are calculated on a calendar-year basis.
Platinum and gold plans will often be more attractive to older workers, who may need more health care services and have a greater chance of having health problems than your younger employees.
Younger workers, if they are healthy, would likely be more interested in a bronze or silver plan, since they tend to visit the doctor less often and are less likely to get sick.
If you have questions about the different metal plans, or your employees want to know more, feel free to contact us.