Metal levels and plan types
Bronze, Silver, Gold and Platinum; deductibles and out-of-pocket maximums; HMO, PPO and EPO networks; and level-funded plans.
Metal levels: who pays at the doctor
- Bronze plans pay about 60% of typical costs, Silver 70%, Gold 80%, Platinum 90%.
- Higher metal: higher premium, lower costs when someone gets care.
Deductible and out-of-pocket maximum
- The deductible is what a person pays before the plan starts sharing most costs.
- The out-of-pocket maximum caps what they pay in a year; after that the plan pays 100% of covered care.
Networks: HMO, PPO, EPO
- HMO: lower cost, care from the plan’s network, usually with a primary doctor and referrals.
- PPO: wider choice, including some out-of-network care, at a higher price.
- EPO: in-network only, but usually no referrals.
Level-funded plans
- You pay a fixed monthly amount; if your group’s claims are low, you may get money back.
- The carrier reviews your group first, so the price comes after you share your employee list.
- Healthy groups can save; your agent can explain the trade-offs.
Prices for your team, soon
DwellZip is launching soon: carriers’ filed rates for your area and your employees’ ages, then options from licensed agents. What’s coming
Next guide: ICHRA in brief