All plans offered in the Exchanges must cover certain Essential Health Benefits. However, insurers are allowed to then vary the benefits, costs, and structures of the plans they offer in order to create an array of options for consumers.
Plans will be arranged according to categories, based on their actuarial value. The insurance plan categories are arranged according to low, medium, and high levels of premiums, cost-sharing, actuarial value, and benefits:
- Bronze level: (plan pays 60% of covered medical expenses, lowest premiums)
- Silver level: (plan pays 70% of covered medical expenses, moderately low premiums)
- Gold level: (plan pays 80% of covered medical expenses, moderately high premiums)
- Platinum level: (plan pays 90% of covered medical expenses, high premiums)
The higher the share of covered medical expenses paid by the plan, the higher the premium cost of the plan, and the lower the consumer’s out-of-pocket cost.
A “benchmark premium” is determined based on the area in which an individual lives and is purchasing the insurance.
However, the plan’s premium is not the only cost for the plan. Plans also have various deductibles, co-payments, co-insurance, and other cost-sharing.