Metal Tiers

Covered California

Metal Tiers: Bronze, Silver, Gold, and Platinum

When the Affordable Care Act was passed, it established metal tiers to make it easier for consumers to compare qualified health plans across insurance companies.

These four coverage levels through Covered California (also known as Obamacare) are sometimes called "metal plans" because of their names: Bronze, Silver, Gold, and Platinum.

What does each tier cover?


To be approved as a qualified health plan in a particular metal tier, the plan must cover a certain different percentage of your health care costs overall. This is sometimes called the plan's “actuarial value.” Here's how much of your care plans in each metal tier will pay:

  • Bronze plans: 60%

  • Silver plans: 70%

  • Gold plans: 80%

  • Platinum plans: 90%

 

Since Bronze plans pay 60% of your care and you pay the other 40%, they cost less on a monthly basis than Gold and Platinum plans. Gold and Platinum plans have higher premiums, but they pay for more of your care if you're sick.

Silver plans are special because a form of financial aid called a cost-sharing reduction (or CSR) can only apply to Silver plans. That means if you qualify based on your income, you are eligible for Enhanced Silver Plan options.

Are there any other marketplace options available?


If you qualify, you may be able to sign up for a catastrophic plan. This type of plan is best only if you want to cover worst-case scenarios since it has a very high deductible but the lowest premiums. Catastrophic plans are only available to people under 30, as well as people of any age who apply for and receive a hardship exemption from the requirement to have health insurance. When you sign up for health insurance on the marketplace, depending on your household size and income, you may qualify for Medi-Cal.

How do I choose the right tier plan for me?


There are a number of factors you should take into consideration when choosing the health insurance plan that's right for you. Call our team of experts to help walk you through the process of selecting the right plan that best fit your needs such as doctor visits and prescription drugs.

A Plan Level for Every Budget

Most services have a small copay and most are not subject to a deductible. Based off of 2020 plan benefits.

Free Preventive Care

(after deductible)

$65* PCP Copay

Bronze

40% after the deductible is met for Emergency Visit.

$18 for Tier 1 Rx
(After Pharmacy Deductible is met)

*Doctor visits for Bronze plans are $65 each for the first three visits. Subsequent visits are full cost until the deductible is met.

Free Preventive Care

$5 to $40 PCP Copay

Silver

$50 to $400

 Emergency Visit

$3-$16 Tier 1 Rx
(Some Silver plans subject to a Pharmacy Deductible)

 *Benefits are subject to Silver plan selection.

Free Preventive Care

$30 PCP Copay

Gold

$350 Emergency Visit

$15 or less

Tier 1 Rx

Free Preventive Care

$15 PCP Copay

Platinum

$150 Emergency Visit

$5 or less

Tier 1 Rx

These examples are intended to show the differences between metal tiers. Your actual copays, coinsurance, and deductibles could vary and will be displayed when you compare specific plans. Minumum coverage (catastrophic) plans are also available for those who qualify, but are not eligible for financial help.

Copay is a fixed amount you pay for a service, with the plan covering the remainder.

Deductible is the amount you pay before your plan starts to pay for services. In most plans, the deductible applies only to inpatient services and prescription drugs.

Coinsurance is a percentage you pay for a service, with the plan covering the remainder.

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“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. This website is owned and maintained by Quote Selection Insurance Services DBA Collective:Choice Insurance Solutions Lic # 0F19743, which is solely responsible for its content. This site is not maintained by or affiliated with Covered California, and Covered California bears no responsibility for its content. The e-mail addresses and telephone number that appears throughout this site belong to Quote Selection Insurance Services DBA Collective:Choice Insurance Solutions and cannot be used to contact Covered California.

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