These categories, designed to simplify insurance shopping, are supposed to represent the plans with the least to most expensive premiums and the smallest to highest percent of health care covered. But in almost two-thirds of 2,511 counties covered by the federal exchange, the highest monthly premium quoted for a bronze plan tops the lowest one for a silver plan. In a quarter of counties, that premium is more than 25% higher. The same is true for the priciest plans, those that are categorized as gold or platinum.
The federal site, HealthCare.gov, borrowed the idea for the metal levels from the Massachusetts health exchange. That state adopted the metal-related tiers of coverage after complaints that all of the plan choices were too confusing for people to navigate through.
Yet the price overlap between the metal levels creates the likelihood that shoppers who assume they can only afford a bronze plan are ruling out plans that may have both more affordable premiums and lower cost-sharing. Bronze plans cover just 60% of out of pocket costs, while silver plans cover 70%. Gold plans cover 80% and platinum plans, typically with the highest premiums, cover 90% of out of pocket costs.
"In the Marketplace, consumers can easily compare plans side by side and find the one that meets their needs," Department of Health and Human Service spokeswoman said in a statement. "We encourage consumers to look at all factors, including premiums, networks, deductibles and cost-sharing to choose the plan that is right for them."
Experts usually advise healthy consumers with lower incomes to choose bronze plans because they require the lowest upfront costs. The chance of higher out of pocket costs in the event of a health setback is a risk some think i! s worth taking — or necessary to take.
But if silver, gold and platinum plans can cost less in premiums than the tier beneath them and cover more out of pocket costs, they'd generally be better bets, depending on whether deductibles or co-pays are prohibitive — if multiple prescriptions are involved, for example.
For instance, in DeKalb County, Ga., the cheapest silver offering for a single adult age 27 is $188 a month; the most expensive bronze offering is $243. A similar gap appears in pricing for other typical customer profiles such as couples, families, an adult who is 50 or a single-parent family.
In York County, Pa., there's actually a gold plan that's cheaper than a bronze plan.
Across all U.S. counties, the gap between the highest-cost bronze and the lowest-cost silver is about $13 a month, or about $156 a year. But in some counties in Arizona, a Meritus Lifestyle Choice Bronze exceeds the lowest silver offerings by up to $200 a month.
For couples, 27- and 50-year-old individuals, almost half of the counties with at least one bronze plan had at least five bronze plans that cost more than the cheapest silver plans. More than 10% had 10 or more bronze plans that cost more than the cheapest silver plan.
More mixed-up metals:
• More than two-thirds (71%) of counties have a more expensive silver plan than the cheapest gold plan, and in more than a quarter of counties, that premium is more than 25% higher.
• About two-thirds of counties have a gold vs. platinum overlap. Nearly half have at least a 10% overlap and a quarter have an overlap of at least 25%.
"There's wide variation with premiums within the tier," says Robert Zirkelbach, spokesman for the industry trade group, America's Health Insurance Plans. But he says the trade group doesn't have data on why insurers price the way they do.
The likeliest reason for the pricing discrepancies, however, is the number of doctors and hospitals participating in a plan — also known as t! he provid! er network. The broader the network, the higher the premiums, Zirkelbach says.
Insurance companies also have to make certain assumptions about what health care costs are going to be, based on who they anticipate is going to enroll. But insurance companies know little about the uninsured people who are going to sign up for insurance next year so, being conservative by nature, some set premiums as it they were preparing for the worst. In most states, insurers also didn't know what their competitors would be charging so wouldn't have known what the going price was for silver, say, in a certain state.
Many consumers will find they qualify for cost sharing subsidies that lower their out of pocket costs even more if they choose a silver plan, says HHS' Peters. Subsidies are calculated based on the percentage of income the second lowest cost silver plan would cost them. So while they may generally find bronze plans have lower premium, they will pay less with a silver plan that has more generous cost sharing, Peters says.
Things should improve, experts say.
"There will be less spread on prices because insurers will have experience (on the exchanges) and they will know what it costs to run these plans and what other people are charging," says Eric Johnson, a business professor at Columbia Business School.
Shopping for health insurance? Tell us your experience at healthinsurance@usatoday.com
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