Health Insurance Glossary

Definitions for common health insurance terms

Obamacare metal plans

DEFINITION: The Affordable Care Act set out to standardize individual health insurance policies by creating a “metal” ranking for policies, with each level based on actuarial value. With a Bronze plan, the policy owner pays roughly 40 percent of costs. That drops to 30 percent on a Silver plan, 20 percent on a Gold plan and 10 percent on a Platinum plan.

But these percentages apply to an entire standard population – they’re aren’t applicable to specific individuals who have coverage under the plan. People with very low overall healthcare spending will typically pay a larger share of their own costs (since they won’t have met the plan’s deductible yet), while a person with exorbitant health care costs during the year might pay only a tiny fraction of the total costs, while the health plan pays the vast majority of the total. And a person who is healthy enough to only need preventive care during the year might end up with 100 percent of her health care costs covered by the plan, regardless of what metal level she has, since specific preventive care is covered with no out-of-pocket costs regardless of the metal level.

Regardless of the level, no ACA-compliant plans can have out-of-pocket maximums that exceed $6,850 for an individual or $13,700 for a family in 2016. These amounts will increase to $7,150 and $14,300 in 2017.