Metal Levels
Overview
Section titled “Overview”ACA marketplace plans are categorized into metal levels based on their actuarial value — the percentage of average healthcare costs the plan covers.
Metal Level Tiers
Section titled “Metal Level Tiers”| Metal Level | Actuarial Value | Monthly Premium | Out-of-Pocket Costs |
|---|---|---|---|
| Catastrophic | ~55% | Lowest | Highest |
| Bronze | ~60% | Low | High |
| Silver | ~70% | Medium | Medium |
| Gold | ~80% | Higher | Lower |
| Platinum | ~90% | Highest | Lowest |
Key Differences
Section titled “Key Differences”Bronze plans have the lowest monthly premiums but highest deductibles and out-of-pocket costs. Best for healthy individuals who want catastrophic coverage.
Silver plans are the most popular tier. They are the only metal level eligible for Cost-Sharing Reductions (CSRs), which lower deductibles and copays for qualifying enrollees.
Gold plans have higher premiums but lower cost-sharing. Good for people who expect moderate to frequent healthcare usage.
Platinum plans have the highest premiums but lowest out-of-pocket costs. Best for people with chronic conditions or frequent medical needs.
Catastrophic plans are available only to people under 30 (or with a hardship exemption). They have very high deductibles but cover three primary care visits and preventive services before the deductible.
Filtering by Metal Level
Section titled “Filtering by Metal Level”Use the metal_level query parameter to filter search results:
curl -H "Authorization: Bearer op_YOUR_API_KEY_HERE" \ "https://api.opelyx.com/v1/health/plans?zip=10001&age=30&metal_level=silver"Valid values: catastrophic, bronze, silver, gold, platinum.