Medical insurance plans cover the costs of healthcare services and use different cost-sharing mechanisms to split the costs between the insured member and the insurance company. The average share of typical services that a plan covers determines its comprehensiveness. With IFPs, the level of comprehensiveness is labeled using Metal Tiers. Higher-tier plans generally have lower cost-shares (deductible, co-insurance, and Max-Out-Of-Pocket). The tiers include:
Platinum: the highest tier and typically the most comprehensive type of plan, aiming to cover an average of 90% of the costs of healthcare services.
Gold: a high-quality but more affordable tier that aims to cover an average of 80% of the costs of healthcare services.
Silver: medium-quality plans that aim to cover an average of 70% of the costs of healthcare services.
Bronze: low-priced plans that aim to cover an average of 60% of the costs of healthcare services and where the member pays a significant share of costs.
Important to note: the costs of healthcare services refer to a statistical assumption around a typical set of healthcare needs for an individual or a family in a given year. These are broad averages made across the entire US population, and much specific medical services end up costing for a member depends significantly on the specific health services, providers, and medication utilized. The metal tier is a directional indication of how much an employee can expect to have covered on average, but it is not a guarantee.