The Affordable Care Act (ACA) burst onto the scene in March 2010, revolutionizing health care. By January 2014, its key features were in full swing, introducing the “Metal Tiers” – a simple way to navigate health plan choices.
The Metal Tier levels – Bronze, Silver, Gold, and Platinum – help you make a cost-conscious decision when shopping for health insurance. The tiers help you predict your cost-sharing for doctor visits or hospital treatments within your health plan’s network. And the “metal” labels aren’t so much about the quality of care you’ll receive bu the costs you might encounter.
Here is a snapshot of the Metal Tiers:
| Plan Category/
ACA Metal Tier |
Portion of Covered Services Paid by the Insurance Company | Portion of Health Care Costs Paid by Insured Patient |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
What To Expect With Each Tier
Choosing the right tier boils down to what works best for your employees and their family’s health care needs and budget. Let’s dive into each tier and delve into what the annual costs could look like :
A Bronze Health Plan:
- Offers the lowest monthly premium
- Includes higher out-of-pocket costs when care is needed
- Can have a deductible (the amount that must be paid before the health plan begins to pay) of thousands of dollars annually
- Is a good choice if you and your employees want a low-cost way to protect yourself from worst-case medical scenarios (such as a serious sickness or injury)
While the monthly premium is lower for a Bronze-tier plan, annual costs could be greater than with a different plan tier. That’s because the deductible and a higher portion of treatment costs must be paid for covered health care services with a Bronze plan.
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 you and your employees are willing to pay a slightly higher monthly premium and want to have more of your 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
For those anticipating a greater need for health care, many experts say a Gold plan can be a good value.
A Platinum Health Plan:
- Has the highest monthly premium
- Offers the lowest cost when care is needed (because it pays the highest percentage for covered services for those seeking treatment)
- Typically has a lower deductible, which must be paid before the health 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
All plans in all tiers include free preventative care and some offer free or discounted services for eligible care before the deductible. Preventive care provisions could change under a legal challenge to the ACA, which is working its way through the courts.
People under age 30 and those of any age with a hardship exemption or affordability exemption may be eligible to purchase a fifth health plan type – a Catastrophic plan. Premiums for a Catastrophic plan are lower than for Metal Tier plans; however, the deductible (the amount that must be paid before the health plan starts to pay) is very high. Adjusted annually, the 2024 Catastrophic plan deductible is $9,450.
Because your group has coverage through CaliforniaChoice, you and your employees have multiple Metal Tier options.
- Total Choice: Choose from coverage in all four Metal Tiers: Bronze, Silver, Gold, and Platinum.
- Triple Choice: Offer three Metal Tier options to employees: Platinum, Gold, and Silver OR Gold, Silver, and Bronze.
- Double Choice: Offer two Metal Tier options to employees: Platinum and Gold OR Gold and Silver OR Silver and Bronze.
- Single Choice: Offer employees coverage in any single Metal Tier: Platinum OR Gold OR Silver OR
Total Choice gives you a way to satisfy all your employees. If you’re not offering it, you should ask your broker about expanding your options at renewal. There’s no cost to you to offer Total Choice, and there are no participation requirements for any single tier.
Metal Tiers and the health plans offered by CaliforniaChoice in 2024
| CaliforniaChoice Metal Tier Availability by Carrier and Plan Type | ||||
| Carrier | Bronze | Silver | Gold | Platinum |
| Anthem Blue Cross | 4 EPOs | 3 HMOs
4 PPOs |
3 HMOs
6 PPOs |
1 HMO
1 PPO |
| Cigna + Oscar | 4 EPOs | 6 EPOs | 4 EPOs | 4 EPOs |
| Health Net | 1 HMO | 3 HMOs
|
9 HMOs
|
8 HMOs |
| Kaiser Permanente | 3 HMOs | 5 HMOs | 4 HMOs | 3 HMOs |
| Sharp Health Plan | 2 HMOs | 3 HMOs | 3 HMOs | 3 HMOs |
| Sutter Health Plus | 2 HMOs | 2 HMOs | 3 HMOs | 2 HMOs |
| UnitedHealthcare | 4 HMOs | 12 HMOs | 11 HMOs | |
| Western Health Advantage | 2 HMOs | 3 HMOs | 4 HMOs | 4 HMOs |
| Total Options | 8 EPOs
10 HMOs |
4 PPOs
6 EPOs 23 HMOs |
4 EPOs
6 PPOs 38 HMOs |
1 PPO
4 EPOs 32 HMOs |
Beyond comprehensive health care with CaliforniaChoice, you and your employees also get access to valuable extras through our no-cost Business Solutions Suite and Member Value Suite, including:
- free Flexible Spending Account for employees (for groups of 15 employees or more)
- free Premium Only Plan (POP) (initial case set-up is covered; fee applies after the first year)
- discounts on Dental, Vision, and Hearing services
- discounts from Cal Perks on movies, theme parks, water parks, museums, sporting events, travel, tax prep, shopping, and more (login at com for details)
- savings of up to 40% on health and wellness, including discounted gym memberships
- a free prescription drug discount card that could reduce out-of-pocket costs to less than the Rx co-pay with your health insurance
- Cal-COBRA or Federal COBRA billing (depending on how many employees you have)
Talk With Your Broker
Ask your employee benefits broker about what to expect as your CaliforniaChoice renewal approaches. As a reminder, you can adjust your contribution toward employees’ premiums – up or down – or add new options for your employees. Your broker will answer any of your questions and provide you with a custom quote for your group renewal.