Am I Being Pushed Into Picking a Silver Health...

  Answer: If you’re buying individual or family health insurance through your state’s health insurance exchange, you may feel as though you’re being prodded to pick a silver-tier health plan. Although you ultimately have free choice to pick any plan the health insurance exchange offers, lawmakers designed the system such that it encourages you to choose a silver plan.How Am I Being Influenced to Choose a Silver Plan?The most blatant evidence that the lawmakers who wrote the Affordable Care Act want you to choose a silver plan involves cost-sharing subsidies. Cost-sharing subsidies lower the amount of deductibles, copayments and coinsurance when you use your health insurance. By lowering the deductibles, copayments and coinsurance without changing the monthly premium, your cost-sharing subsidy effectively gives you a free upgrade on health insurance.Cost-sharing subsidies will only be given to people who choose a silver health plan. If you meet the income eligibility criteria for a cost-sharing subsidy by having an income of less than 250 percent of federal poverty level, you must choose a silver–tier plan to get the subsidy. If you pick a lower cost bronze-tier health plan, or a higher cost gold or platinum-tier health plan, you won’t get the cost-sharing subsidy. This will obviously influence your decision about whether to choose a silver-tier plan over a bronze, gold or platinum health plan.A more subtle indicator that the design of the Affordable Care Act encourages you to choose a silver plan comes in the form of the premium tax credit subsidy. If you’re eligible for the premium tax credit subsidy, the federal government will pay part of the monthly premium for your health insurance. In effect, the premium subsidy gives you a discount on the cost of health insurance. To be eligible for the premium subsidy, your income must be from 100-400 percent of federal poverty level.The dollar amount of this subsidy is based on comparing your income to the price of the second-cheapest silver-tier health plan available on your state’s health insurance exchange. The design of the premium tax credit subsidy strives to make a silver-tier plan affordable for people of modest means.Gold-tier health plans have an actuarial value closer to the average value of employer-sponsored health insurance than silver-tier plans do. The Affordable Care Act could have stipulated that the premium subsidy be based on a comparing your income with a higher-valued gold-tier health plan. This would have had the effect of making gold-tier plans more affordable for people of modest means.Since lawmakers chose to base the premium subsidy on the cost of a silver-tier health plan rather than on a gold-tier plan, or on a lower cost bronze-tier plan, it could be construed as encouraging people receiving premium tax credit subsidies to choose a silver-tier plan.Unlike the cost-sharing subsidy, you’ll still get the premium subsidy if you choose a bronze plan, a gold plan or a platinum plan. But, you’ll pay the difference if you choose a more expensive plan than the one used to figure the amount of your subsidy. To learn more about the premium tax credit subsidy, read, “How Does the Health Insurance Subsidy Work?”To learn more about the how the tier system works and what it tells you about the value of a health plan, read, “Bronze, Silver, Gold & Platinum—Understanding the Metal-Tier System.”

Silver Plan–What Is It?

  Definition: A silver health plan is a standardized type of health insurance that pays, on average, 70 percent of your health care expenses. You pay the other 30 percent of your health care expenses in the form of copayments, coinsurance and deductibles.BackgroundTo make it easy for you to compare the value you’re getting for the money you spend on health insurance premiums, the Affordable Care Act standardized value levels for health plans. These levels, or tiers, are bronze, silver, gold, and platinum. All of the health plans within a given level are expected to offer the same overall value. For silver-tier plans, the value is 70 percent. Bronze plans offer a 60 percent value; gold plans are valued at 80 percent; platinum plans offer a value of 90 percent.What Does Value Mean When Talking About Health Insurance?The actuarial value tells you what percentage of covered health care expenses a plan is expected to pay for its membership as a whole. This doesn’t mean that you, personally, will have exactly 70 percent of your health care costs paid by your silver plan. It’s an average value spread across all of a plan’s members. Depending on how you use your health insurance, you might have more or less than 70 percent of your expenses paid.Non-covered health care expenses don’t count when determining a health plan’s value. For example, if your silver-tier health plan doesn’t provide coverage for over-the-counter medicines, the cost of them isn’t included when calculating your plan’s value.What Will I Have to Pay With a Silver Plan?You’ll have to pay monthly premiums to get the health plan coverage. Silver plan premiums are more expensive than bronze-tier plans because silver-tier plans expect to pay out more money toward your health care bills than bronze plans do. Likewise, silver plan premiums tend to be less expensive than gold or platinum-tier plans since silver plans expect to pay out less toward your health care bills.In addition to your monthly premiums, each time you use your health insurance, you’ll have to pay cost-sharing like deductibles, coinsurance and copays. How each silver plan makes you pay your 30 percent share will vary. For example, one silver plan might have a high $2000 deductible paired with a low 20 percent coinsurance. A competing silver plan might have a lower $1000 deductible paired with a higher coinsurance and a $40 copay for prescriptions.Why Should I Choose a Silver Plan?Choose a silver health plan if you’re looking to balance the cost of your monthly premiums with the cost of your out-of-pocket expenses like coinsurance and deductibles. If you want to avoid the high premium costs of gold and platinum plans, but also want to protect yourself from the possibility of having to pay an entire 40 percent of your health care expenses as you would with a bronze plan, a silver plan might work for you.If you’re eligible for cost-sharing subsidies because your income is below 250 percent of federal poverty level, you must choose a silver-tier plan to get the subsidies. You won’t get the cost-sharing subsidies if you choose a health plan from any other tier.Cost-sharing subsidies lower your deductible, copays and coinsurance so that you pay less when you use your health insurance. In effect, a cost-sharing subsidy increases the value of your health plan without raising the premium. It’s like getting a free upgrade on value. You won’t get the free upgrade unless you choose a silver health plan.Why Should I Avoid a Silver Pan?You shouldn’t choose a silver health plan if you can’t afford to pay approximately 30 percent of the cost of your health care expenses. If you’re trying to limit your expenses each time you use your health insurance, you’ll do better with a gold or platinum plan.If you use your health insurance a lot, perhaps because you have an expensive chronic condition, take a careful look at the silver plan’s out-of-pocket maximum. If you know in advance that your out-of-pocket expenses will exceed this out-of-pocket maximum, you might be able to save money by choosing a bronze-tier plan with a similar out-of-pocket maximum but lower premiums. Your total yearly out-of-pocket expenses will be the same, but you’ll pay less for premiums. You can read more about how this technique works in, “How To Save on Health Insurance if You Reach the Out-Of-Pocket Maximum.”

Bronze, Silver, Gold & Platinum–Understan...

aIf you’re trying to choose a health plan or compare health insurance plans in the United States, you need to understand the metal-tier system. The Affordable Care Act standardizes how health plans are valued. Starting January 1, 2014, health plans fall into one of four categories: bronze, silver, gold or platinum.The metal tier tells you the actuarial value of the health plan. It's a simple way of comparing the value of one health plan to another. All health plans on the same metal tier have the same actuarial value.What Does Actuarial Value Mean?The actuarial value of a plan tells you what percentage of health care costs that health insurance plan is expected to pay for its beneficiaries. A plan with an actuarial value of 60 percent is expected to pay approximately 60 percent of the health care costs of its beneficiaries. The plan’s beneficiaries will pay the other 40 percent of their health care costs in the form of deductibles, coinsurance, and copayments.Actuarial value is calculated for the health plan as a whole, not for individual members. So, on average across all of a health plan’s subscribers, the actuarial value describes the percentage of health care expenses that will be paid by the plan. However, the percentage of your health care expenses the plan will pay will vary depending on how you use your health insurance.For example, let’s say your health plan has an actuarial value of 80 percent. If you only use your health insurance once all year long, perhaps to visit an urgent care clinic for a case of the flu, you may find that your health plan doesn’t pay anything at all toward your health care expenses that year. If you hadn’t met your deductible that year, you’d likely end up paying the urgent care bill yourself. The money you paid would be credited toward your deductible. In this case, your health plan certainly didn’t pay for 80 percent of your health care expenses. You paid for 100 percent of your health care expenses.However, across the entire plan membership, individual cases like the example above would be balanced by cases in which the health plan paid 100 percent of the bill for preventive care services like yearly physical exams and birth control. Those people didn’t pay anything toward their own health care expenses that year. When the expenses of all of the plan’s subscribers are totaled at the end of the year, a plan with an actuarial value of 80 percent should have paid 80 percent of the health care expenses of all of its beneficiaries together.Actuarial value calculations don’t include health insurance premiums or things the health plan doesn’t cover. For example, if your health insurance doesn’t cover weight loss surgery, the cost of weight loss surgery wouldn’t be included when coming up with the value of the health plan.How Do Metal Tiers Relate to Value?Bronze-tier health plans have a value of 60 percentSilver-tier health plans have a value of 70 percentGold-tier health plans have a value of 80 percentPlatinum-tier health plans have a value of 90 percentBy using the metal-tier system, people who don’t understand exactly how actuarial value works still understand intuitively that a gold-tier plan is worth more than a bronze-tier plan.Should I Choose Bronze, Silver, Gold or Platinum?Base your choice of metal tier on a balance of how much you’re willing to pay in premiums with how much coverage you need. Higher value plans have higher premiums, but they pay a higher percentage of your health care expenses than lower-cost, lower value plans.Each of the articles below includes sections on who should consider and who should avoid that particular metal tier. If you’re choosing a health plan, once you’ve determined the plan’s metal tier, make sure you’re not on the list of people who should avoid that tier.Your eligibility for government subsidies may influence your choice of metal tiers. If you’re eligible for a government cost-sharing subsidy to help you pay for your deductibles, copays, and coinsurance, you won’t get the subsidy if you don’t buy a silver-tier health plan using your state’s health insurance exchange. To learn more about subsidies, read, “Can I Get Help Paying for Health Insurance?”If All Plans on a Given Tier Are the Same Value, Why Not Just Pick the Cheapest?Although all plans on a given tier will have the same actuarial value, they'll differ in other ways. Take those differences into account when choosing a plan; pick a plan that works well for your situation.For example, one gold plan might have a deductible of $1,500 and coinsurance of 15 percent. Another gold plan might have a low deductible paired with higher coinsurance and prescription copays. If you can’t afford to pay the larger deductible before your health insurance kicks in, you might choose the plan with the lower deductible even if it has slightly higher premiums. You know the actuarial value of all gold plans is the same, so your choice is being made based on how you’d like to use the insurance rather than on how much it's worth.Other comparison points include the health plan’s network. Is your doctor in-network with the all of the health plans you’re comparing? Is each plan’s network of providers large enough to give you a choice of providers if you decide you don’t like a particular physician or hospital and want to switch to another?Does one plan offer you more freedom of choice than another? HMOs generally won’t pay for care you get out-of-network. However, PPOs will pay for out-of-network care, but at a lower rate than if you had stayed in-network. Are you willing to pay higher premiums for a plan that allows you to get care out-of-network if you wish? Or would you rather give up that freedom of choice, but pay lower premiums?Are the quality scores for one plan much better than for a competing plan? Are the premiums for one plan significantly lower than for competing plans with similar quality scores?If you plan to use your health insurance a lot, compare the out-of-pocket maximums of the plans. If one plan has a significantly lower out-of-pocket maximum than the other plans on the same tier, you might save money choosing the plan with the lower out-of-pocket maximum. You’ll find more information about how this technique works in, “How To Save on Health Insurance if You Reach the Out-Of-Pocket Maximum.”

Silver Plan–What Is It?

a Definición:Un plan de salud de plata es un tipo estandarizado de seguro médico que paga, en promedio, 70 por ciento de sus gastos de cuidado de la salud. Usted paga el otro 30 por ciento de sus gastos de cuidado de la salud en la forma de los copagos, coseguros y deducibles.FondoPara que sea fácil para usted para comparar el valor que te por el dinero que gastas en primas de seguro de salud, el Affordable Care Act normalizados los niveles de valor para los planes de salud. Estos niveles, o niveles, son de bronce, plata, oro y platino. Todos los planes de salud dentro de un determinado nivel se esperan que ofrezcan el mismo valor total. Para los planes de nivel de plata, el valor es del 70 por ciento. Planes de bronce ofrecen un valor de 60 por ciento; planes de oro son valorados en 80 por ciento; platino planes ofrecen un valor de 90 por ciento.¿Qué significa valor cuando se habla de seguro de salud?El valor actuarial te dice qué porcentaje de los gastos médicos cubiertos se prevé un plan para pagar su membresía en su totalidad. Esto no quiere decir que, personalmente, tendrá exactamente el 70 por ciento de sus costos de atención médica pagados por su plan de plata. Es un valor promedio repartidos en todos los miembros de un plan de. Dependiendo de cómo usar su seguro de salud, tendrás más o menos de 70 por ciento de sus gastos.Gastos médicos no cubiertos no cuentan para determinar el valor de un plan de salud. Por ejemplo, si su plan de salud de nivel plata no provee cobertura para medicamentos de venta libre, el costo de ellos no incluyeron al calcular el valor de su plan.¿Tendré que pagar con un Plan de plata?Tendrás que pagar primas mensuales para obtener la cobertura del plan de salud. Las primas del plan plata son más caras que nivel bronce planes porque planes de nivel Plata esperan pagar más dinero hacia sus cuentas de atención médica que hacer planes de bronce. Asimismo, las primas del plan plata tienden a ser menos costoso que planes de oro o platino nivel puesto cuentan con planes de plata pagar menos hacia sus cuentas de atención médica.Además de sus primas mensuales, cada vez que usas tu seguro médico, tendrás que pagar gastos como los copagos, deducibles y coseguro. Cómo te hace pagar su cuota de 30 por ciento cada plan plata variará. Por ejemplo, un plan de plata podría tener un deducible alto $2000, acompañado de un coseguro del 20 por ciento bajo. Un plan plateado competencia podría tener un deducible de $1000 inferior apareado con un coseguro superior y un copago de $40 para las prescripciones.¿Por qué debo elegir un Plan de plata?Elija un plan de salud plata si usted está buscando para equilibrar el costo de sus primas mensuales con el costo de sus gastos como deducibles y el coseguro. Si quieres evitar los costos de alta calidad de oro y platino planes, pero también quiere protegerse de la posibilidad de tener que pagar un entero 40 por ciento de sus gastos de cuidado de la salud como lo haría con un plan de bronce, un plan de plata podría funcionar para ti.Si usted es elegible para los subsidios de gastos porque su ingreso está por debajo de 250 por ciento del nivel federal de pobreza, se debe elegir un plan de nivel plata para conseguir las subvenciones. No te las subvenciones gastos si usted elige un plan de salud de cualquier otro nivel.Subsidios de gastos bajen sus deducibles, copagos y coaseguro de modo que usted paga menos cuando utilizas tu seguro médico. En efecto, un subsidio de costo compartido aumenta el valor de su plan de salud sin tener que elevar la prima. Es como recibir una actualización gratuita en valor. No te la actualización gratuita a menos que usted elige un plan de salud de plata.¿Por qué debo evitar una bandeja de plata?Usted no debería elegir un plan de salud plata si usted no puede permitirse pagar aproximadamente el 30 por ciento de los gastos de su atención médica. Si usted está tratando de limitar sus gastos cada vez que usas tu seguro de salud, harás mejor con un plan de oro o platino.Si utilizas tu seguro médico mucho, quizás porque usted tiene una condición crónica cara, tomar una mirada cuidadosa en el desembolso máximo del plan plata. Si sabes de antemano que sus gastos superará este desembolso máximo, usted podría ahorrar dinero al elegir un plan de nivel bronce con una similar primas máximo pero menor desembolso. Sus gastos de desembolso anuales totales será el mismo, pero usted tendrá que pagar menos por las primas. Puedes leer más acerca de cómo funciona esta técnica, "Cómo a ahorrar en seguro de salud si alcanzas el desembolso máximo."