What are Metal Tiers and Which One Do I Choose?
Most of us would rather endure intensive physical pain than have to choose a healthcare plan (glass shard and habanero pepper milkshake? Sounds like a great alternative to me). Fortunately, Stride’s mission is to make this process far less painful.
There is no “one size fits all” when it comes to buying coverage - everyone is unique in their healthcare needs. To simplify the process, health plans are broken down into categories called “Metal Tiers” – plan options that are similar in their costs and coverage. They are named in order of the precious metals: Bronze, Silver, Gold, and Platinum.
The Bronze plans have the least expensive monthly payments but offer the lowest amount of coverage, whereas Platinum plans have the most expensive monthly payments but offer the greatest amount of coverage.
I like to compare health insurance shopping to buying a car. A Bronze plan is like buying a used car with a bunch of mileage - this car is going to get you around town and cover your basic needs. However, it’s not the best for that big cross country road trip, and it will cost you a lot when you need to repair it.
Bronze plans are best for people who don’t typically need or use healthcare. Are you looking for a yearly doctor’s checkup and maybe some prescription coverage? Maybe you just need minimal coverage that will prevent bankruptcy in case of an emergency? Bronze could be for you. The upside is that it will be cheaper up front; the downside is that anything other than preventative care (think: a sprained ankle) is going to cost full price. For a single person, yearly out-of-pocket maximums are close to $7,000. For many people, Bronze plans are great, but know what you are getting into: make sure you can afford your out-of-pocket maximum and don’t end up with regret if you have a medium-sized medical cost, like this customer.
A silver plan is like your minivan – it’s a solid choice but not the most flashy. These plans cover more needs and will get you across state lines, but they’re not perfect for everything (might not be the best ride to impress a date). Silver plans typically have a lower deductible and out-of-pocket maximum (than Bronze plans) and will cover all prescription drugs and most doctor’s appointments. Do you use your healthcare for more than just preventative care, but don’t have any major medical needs (such as surgery or disease maintenance)? A Silver plan could be right for you.
Next, a gold plan is that hearty pickup truck (or fuel efficient Prius). This plan is going to be more expensive but the benefits could outweigh the costs. It’s reliable, cost-efficient in the long run, and keeps you safe. We recommend these plans for people who already know they have quite a few healthcare needs, including pregnancy and more intensive health maintenance. You’ll pay more on monthly premiums, but your deductible will be quite low (the amount you pay BEFORE your insurance “kicks in”) and therefore you will end up paying less for your surgeries or illnesses.
Lastly, we have the Platinum plan, which is kind of like driving a Tesla – it’s expensive upfront and not a need for everyone. But once you have it, you feel like you are wearing an iron suit of protection. In the long term, it will give you the most coverage. This plan is not necessary for most people. However if you can afford the higher premiums and you know that you are going to need a LOT of coverage this year, this plan will provide you with the most savings.
Financial Risk Assessment
If you’re still unsure which plan is right, here’s a quick way to financially assess your risk between two plans. Say you’re deciding between a Bronze plan ($220 monthly payment | $6500 deductible) and a Silver plan ($255 monthly payment | $1500 deductible).
If you stay completely healthy, you’ll pay $420 less per year [ ($255-$220) x 12 ] with the Bronze plan. BUT, let’s say you hit your head playing flag football and visit the ER with a concussion. That ER visit could cost as much as $4,000. Under the Bronze plan, you’ll pay the whole $4,000 out-of-pocket. With the Silver plan, you’ll pay only your deductible of $1,500, and your insurance will cover the rest. With that ER visit alone, you just saved $2,500 ($4,000 - $1,500) buying the Silver over the Bronze.
Plan selection comes down to this delicate decision matrix: your financial situation, your best guess on how much care you need next year, and your risk profile. Happy health plan hunting, and let us know if we can help you make your best decision.