Just in time for Open Enrollment, SmartFinancial, a leading insurance-technology company, published an article simplifying the tier-system, which most Americans find downright confusing.
“The value of each tier is important to keep in mind when you choose your health plan,” said Lev Barinskiy CEO of SmartFinancial. “Otherwise, you may not be making the best decisions that result in savings.”
SmartFinancial makes navigating the world of healthcare options easy by partnering with the nation’s leading insurance providers to offer thousands of consumers a wide range of affordable options. SmartFinancial focuses on providing actionable advice and rich tools to help insurance customers compare and find the best insurance coverage.
Platinum, Gold, Silver and Bronze: What Does it All Mean?
The value of each of these metals is reflected in the extent of coverage and price of the health plans found in the marketplace. This means that premiums for platinum health care plans will cost the most in monthly premiums, but they will also cover more health care needs so the consumer doesn’t pay as much out-of-pocket when visiting doctors and specialists. The consumer also pays less for treatments and surgery.
Bronze health plans cost the least monthly but when visiting a doctor, the consumer pays more than they would with a higher-tier plan.
In a platinum plan, the consumer only pays roughly 10% of the cost of a healthcare provider’s services. Compare that to paying 40% out of pocket with a bronze plan.
It makes sense for a young, healthy person, who does not see a doctor more than once a year, to buy the bronze plan. Of course, there are sometimes unforeseen circumstances, like a sudden illness or accident, that may require more doctors visit and possibly a hospital stay, which would end up being very costly at 40% of the cost out-of-pocket. For this reason, even the healthiest young person who doesn’t have an emergency fund may be better off with a silver plan (paying 30% of costs) or even gold (paying about 20% of costs). In the end, it’s the consumer's choice to take as much risk as they see fit.
Overall, the majority of Americans opt for a silver tier health insurance plan. It's a good idea to calculate the number of annual doctor visits. If it is only one or two times, a platinum plan may be a waste of money, unless the consumer became gravely ill, or has a debilitating accident.
A Health Plan Fits Should Fit One's Lifestyle and Budget
If a consumer's kids are in high school or up to the age of 26 and on their plan, it may not be a bad idea to buy a bronze plan, but only if everyone is healthy and not involved in sports activities or any risky hobbies. Generally speaking, it’s not advised for people over the age of 70 to be on such a bare-bones plan.
A silver plan may be right if the consumer is under 70 years old and has elementary-school age kids who are not involved in any activities that would expose them to injury. This plan is advised over a bronze one if a family member sees a doctor and/or specialist a few times a year and only requires one or two medications.
If a family member has a condition that needs closer monitoring, the gold plan is preferable. This plan is for those who have frequent doctor visits and need expensive medication. Older people and younger children who see the doctor more frequently should be on this or a platinum health plan.
A platinum plan may be expensive but it may be cheaper overall if a family member suffers from a chronic condition that also requires frequent trips to medical care providers. If they take several expensive medications, this tier plan can be very cost effective. A platinum plan is perfect for the elderly and those prone to illness and injury.
At a Glance:
Lowest monthly premiums
Highest out-of-pocket costs
This is really meant for emergency medical situations for people who are otherwise very healthy.
Moderate monthly premiums
This is a good plan for an individual or family that needs routine care only
High monthly premium
Low out-of-pocket costs
This is a great plan for someone who needs routine care on a regular basis and can pay a little more each month as opposed to paying more for each visit.
Highest monthly premium
Lowest out-of-pocket expenses
Very low deductibles
This is a great plan for someone who regularly needs care and can pay higher monthly premiums while having most if not all costs covered.
What About Short-Term Medical Plans?
Short-term medical insurance (also called temporary health insurance and term health insurance) is also becoming very popular in underserved demographics and with people who need to fill gaps in coverage. People often elect term health insurance before they are eligible for Medicare, while waiting for other coverage to begin or if they are between jobs.
“Let us help you find the right coverage at the right price,” says Barinskiy. “SmartFinancial has built a recommendation engine that takes the guesswork out of the process of shopping hundreds of the most popular plans.”
Compare multiple health insurance plans by starting a quote with SmartFinancial or call 855-214-2291. Our licensed agents are always available to discuss plans coverages in detail and make recommendations based on that individual's unique needs.
SmartFinancial is a leading insurance technology company. Its mission is to provide consumers clarity and savings with its insightful data and intelligent carrier-matching process. Founded by a team of insurance and technology experts, SmartFinancial focuses on delivering measurable results and exceptional service. With offices in Columbus, OH and Costa Mesa, CA, the company ranked 227 on Deloitte’s Technology Fast 500™.