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VIDEO FAQ: How do the new benefit structures work with the new health insurance plans?

By on September 23rd, 2013
Filed: Advice, Health Reform

FAQ: How do the new benefit structures work with the new health insurance plans?

In 2014, all major medical health insurance plans for individuals and small employers will have these new bronze, silver, gold and platinum benefit levels.

And, any plan with an effective coverage date after March 23, 2010 – in the individual and small group health insurance markets will have to meet one of these four benefit levels.

These new bronze, silver, gold and platinum benefit levels actually refer to a plan’s actuarial value level… or “AV.”

What is an actuarial value?

The easiest way to explain it is to say that it is the percentage of total average costs for the benefits a plan covers within a given year.

So, a plan with a 70% actuarial value would typically cover 70% of the costs and the customer would typically be responsible for 30% of the costs.

The different “AVs” have metallic designations:

  • A bronze plan is 60 percent
  • A silver plan is 70 percent
  • A gold plan is 80 percent
  • A platinum plan is 90 percent

Insurers may also offer catastrophic-only coverage to eligible individuals, which would have higher cost-sharing than the standard Metallic plans.

“Metal levels” are designed to allow consumers to compare plans with similar levels of coverage, based on monthly premiums, provider networks, and other factors with the goal of helping consumers make more informed decisions.




About Nate Purpura

Nate Purpura is a 15-year veteran of print and broadcast journalism, corporate communications, PR and internet marketing. He’s spent the last decade working in the health care and insurance industries. Over fifteen years he’s covered numerous areas of health care including pharmaceuticals, health and wellness programs, chronic disease management programs, cutting-edge diagnostic tools, Medicare and health insurance, and online marketplaces (exchanges).

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