The Health Reform Metallic Plans
and Health Subsidies
There are all kinds of new terms ushered in with
the Health Reform bill and one of the most original
is the Metallic Plan. What are these shiny new
(and they are all brand new) health plans and what
do they have to do with any potential health subsidy
available to Americans. Great question and
there are very significant ties between the new
Metallic Health Plans and Subsidies. Let's
take a look at the plans and this all works.
what are the Metallic health plans?
The ACA Health Reform bill proposed that four
different plan levels would be offered in the Health
Exchange plus one catastrophic option for people
under age 30. The four basic levels are
Platinum, Gold, Silver, and Bronze. Roughly
speaking, the Platinum should cover 90% of the
average health care costs leaving 10% to the
enrollee. The Gold would cover 80% of this
"actuarial value". The Silver would cover 70%
and the Bronze would cover 60% of the expenses.
That's how they were crafted. The catastrophic
option for younger people would cover 50%. The
bill further stated that a plan available on the
Exchange must also be offered off the Exchange but
health subsidies are only available in the Exchange.
You can quote health plans both in the Exchange or
out through our Quote Page starting Oct 1st, 2013
when they come online. So, how do these new
plans tie with any proposed health subsidy?
Silver is the new black (for
The Health Reform bill further stipulated that
the health subsidy, if a person is eligible, will
apply to any Metallic health plan in the Exchange
but the cost sharing benefit will only apply to the
Silver plan. Why not the
other plans? The thought was that if a person
can qualify for a subsidy based on having an income
under 400% of the Federal Poverty Level, the Bronze
benefits would not be rich enough (too high out of
pocket for medical bills) and the Platinum and Gold
would be too expensive (even with subsidized
amount). The Silver therefore became the lucky
target of any health subsidy as part of the bill.
There is another Benefit Upgrade Rule which we'll
discuss separately for those making up to 250% of
the Federal Poverty Level. Each State might
interpret the rules slightly differently but let's
assume that the Silver health plan is the plan that
will offer you a subsidized premium if you are
How will the Silver plan
enrollment work with the Health Subsidy?
The process is supposed to be pretty streamlined.
When you run your health plan quote, the system will
automatically request income information to
establish if you qualify for a health subsidy.
You can then quote Health Exchange plans that are
eligible for the Subsidy and it will only charge you
for the net premium (total premium minus the subsidy
based on income, family #, etc). You will be
billed going forward for the net amount of premium
monthly. This is great news as it doesn't
require the applicant to pay the full amount up
front and recoup the subsidy later on (at tax time
for example). Starting Oct 1st, 2013, you can
run your Health Quote with and without Subsidy at no
cost to you.
Los Angeles, Family of 4
Adult making $30K
on age, expected costs, and other assumptions
according to Kaiser Calculator. Actual
subsidies will vary and official subsidy amounts
will be available Oct 1st, 2013.