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Helping Texans Compare & Understand Their Health Care Options

Compare Premiums and Metal Levels

Use the information in this section to help you make better decisions when choosing a health plan.

What Decides Your Premium?

A premium is the amount of money you pay to have health coverage.  If you have an individual or small group health plan, a health plan will look at three things to decide how much your premium will cost.

  1. Your Age.  Health plans can charge older people up to three times more than younger people.  People are more likely to need health care services as they age.  You should expect your premium to go up a little each year due to aging.
  2. Where You Live.  Health care availability and costs in your area can have a big effect on your premium.
  3. Whether You Use Tobacco.  Health plans can charge tobacco users up to 50 percent more than non-users.

Subsidies

Depending on your income, you may be eligible for federal health care subsidies to lower your premium and out-of-pocket costs.  These subsidies are only available when you buy a plan through healthcare.gov.
Learn more about federal subsidies

Metal levels

Health plans are grouped according to how much they will pay for your health care.  Because they’re named after metals, these groupings are called “metal levels.”  Picking the metal level that’s right for you depends on your health care needs and your budget.

Metal Levels:
Plan pays on Average / You Pay on Average
Bronze Silver Gold Platinum
60% / 40% 70% / 30% 80% / 20% 90% / 10%

Platinum plans are the most generous and more expensive.  On average, they pay 90 percent of medical expenses.  Gold plans pay 80 percent, silver plans pay 70 percent, and bronze plans pay 60 percent.  Another category of individual plan is the catastrophic plan.  Catastrophic plans cover less than 60 percent of your medical expenses.  A catastrophic plan must meet the same requirements as other plans, but benefits (beyond preventive services and three primary care visits) are not available until you meet the out-of-pocket maximum.  Catastrophic plans are an option only for people under the age of 30 or others who have received a “hardship exemption” from healthcare.gov.
Learn more about metal levels

Choosing a metal level.  Here are some questions to ask yourself:

  • Is my family typically healthy with few medical needs?  Does anyone in my family have a chronic illness that requires frequent care?
  • Am I eligible for a catastrophic plan?  If so, do I only want a safety net for catastrophic events?
  • Does anyone in my family have a job or hobbies that are risky?
  • Will my employer pay any of my premiums?  If so, how much will my employer pay?

A lower metal level plan costs less in monthly premiums, but remember that you will have to pay more out of pocket when you need care.  If you choose a lower metal plan, consider setting aside the money you save in premium payments to help pay any out-of-pocket costs.  Some plans offer a health savings account for this purpose.

A higher metal level, such as a gold or platinum plan, costs more per month but will cost less out of pocket when your family has a doctor or hospital visit.  If you have frequent medical visits, higher metal level plans can save you money over time.  You also should consider a higher metal level if you or anyone in your family has a risky job or hobbies.

Next Section: Compare Other Health Plan Costs



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Last updated: 10/06/2015