Minimum Value and Actuarial Value

What do those metal tiers mean?
For individuals with employer-sponsored health coverage, if the plan meets the Minimum Value standard and is considered “affordable” for the employee, then he or she will not be eligible for a premium tax credit on the Covered California or Nevada Health Link marketplace. 

A health plan meets the Minimum Value standard if both of the following apply:

  • The plan is designed to pay at least 60% of the total cost of medical services.
  • Plan benefits include substantial coverage for physician and inpatient hospital services.
Actuarial Value refers to the percentage of total average costs for covered benefits that a health plan will cover. More simply, it reflects how costs are shared by the insured and his or her health plan. If a plan has an Actuarial Value of 70%, the plan would pay 70% of total average costs for covered benefits, while the insured would be responsible for 30% of the total costs of covered services.

Here is a snapshot of the ACA Metal Tiers and Actuarial Values:
Plan Category/ ACA Metal TierPortion of Covered Services Paid by Insurance Company (Actuarial Value)Portion of Health Care Costs Paid by the Insured

A Bronze health plan:
  • Offers the lowest monthly premium
  • Includes higher out-of-pocket costs when care is needed
  • Can have a deductible of thousands of dollars annually (which must pay before the health plan begins to pay)
A Silver health plan:
  • Offers a moderate monthly premium and moderate costs when care is needed 
  • Has a deductible that is typically lower than a Bronze-tier plan
  • Is a good choice if for those willing to pay a slightly higher monthly premium and who want to have more routine care covered
A Gold health plan:
  • Has a higher monthly premium (than a Bronze- or Silver-tier plan)
  • Offers lower costs when care is needed (because the plan pays a greater portion of the costs for covered services and the deductible is typically less than with a Silver or Bronze plan)
  • Is a good choice for those willing to pay more each month to have a larger portion of health care costs covered when care is needed
A Platinum health plan:
  • Has the highest monthly premium, but typically offers the lowest cost when care is needed
  • Typically has a lower deductible (the amount paid before the plan begins to pay)
  • Is a good plan choice for those willing to pay more each month to have a greater percentage of eligible medical services covered when seeking care