Minimum Value & Actuarial Value

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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 Tier	Portion of Covered Services Paid by Insurance Company (Actuarial Value)	Portion of Health Care Costs Paid by the Insured
Bronze	60%	40%
Silver	70%	30%
Gold	80%	20%
Platinum	90%	10%

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