- Broker Resources
- ACA Compliance Collateral & References
- 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.
Here is a snapshot of the ACA Metal Tiers and Actuarial Values:
|Plan Category/ ACA Metal Tier||Portion 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)
- 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
- 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
- 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