Understanding the Metal Tiers
Health coverage offered through Covered California comes in four “metal” levels and a fifth category for minimum coverage (catastrophic). The levels determine how much the member pays versus how much the health insurance company pays. They have nothing to do with the quality or amount of care the member gets.
Each of the plan levels is based on the total average costs for benefits that a plan covers. The total includes the monthly premium, deductible, copayments, coinsurance, and out-of-pocket maximum. On average, the split between who pays what is:
|Category||Percentage of expenses|
|Paid by health plan||Paid by individual|
|Basic||Less Than 60%||More Than 40%|
Minimum coverage plans are catastrophic plans. They pay less than 60% of the total average cost of care. They’re available only to people who are under 30 years old or who have a hardship exemption.
Note! The actual percentage a person pays in total or per service depends on the services he or she uses during the year.