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EHB regulation: "Metal levels" will define health insurance value
The final rule on Essential Health Benefits requires all new small group and individual market plans to cover Essential Health Benefits in ten categories, including mental health and substance use disorder services, "at parity" with medical and surgical benefits.
Insurers and employers, not surprisingly, are mainly focused on the bottom tier of plans: bronze. Silver and gold plans will, by definition, offer a higher percentage of coverage for services, likely through lower deductibles and lower co-pays. However, they would also come with higher premium costs. Insurers are developing many bronze plans in the belief that people buying health plans on the insurance exchanges will be looking for plans with the lowest premiums, although such plans will also be those with the barest benefits.
“Metal level” of health plan | Actuarial value (percentage of total allowed costs of medical coverage that will be paid by the plan) |
Platinum | 90 % |
Gold | 80 % |
Silver | 70 % |
Bronze | 60 % |
