Bronze Plans: the Old, the New, and the Numbers

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Bronze plans are a category of coverage in the individual health insurance marketplace. They have to cover certain services and can be used with certain subsidies. And, as you may have noticed, they have the lowest premiums. To learn more about bronze plan coverage, costs, and more, keep reading.

What Is a Bronze Plan?

A bronze plan is a plan category in the Affordable Care Act marketplace. This plan category describes individual health insurance plans with the least expensive premiums and the highest copays and coinsurance amounts. Additionally, bronze health plans often have high deductibles. Because the premium costs are low—but the out-of-pocket costs (copays, deductibles, etc.) are high—these plans are ideal for people who are generally healthy, do not use medical services often, and only need protection in the off-chance they experience an illness or injury.

What Does the Bronze Plan Cover?

All bronze plan coverage must include 10 services that have been deemed essential. These 10 essential benefits include coverage for:

  1. Prescription drugs: Bronze plans will have prescription drug coverage built in.
  2. Pediatric services: For children, plans include dental, vision, and medical coverage.
  3. Preventive, wellness, and chronic disease management services: This includes services, physicals, and diabetes screenings.
  4. Emergency services: Essential emergency care is covered.
  5. Hospitalization: Plans must cover the care you receive in the hospital if you are admitted.
  6. Mental health and addiction services: Even bronze plans are required to provide some level of coverage for services such as counseling and psychotherapy.
  7. Pregnancy, maternity, and newborn care: Treatment for women (and babies) before, during, and immediately after birth is covered.
  8. Ambulatory services: Certain outpatient care services must be covered by all plans. The services and amount covered will be listed in a Summary of Benefits document.
  9. Laboratory services: Specific tests that diagnose illness, measure the effectiveness of treatment, or are utilized as preventive screenings must be covered.
  10. Rehabilitative and habilitative services and devices: Services such as physical or speech therapy must be covered by every plan.

In addition to the 10 essential benefits, health insurance companies have the opportunity to include additional coverage. You can check a specific bronze plan’s coverage by reviewing their Summary of Benefits. Each plan will have an individual Summary of Benefits, where coverage details and costs are listed.

Bronze Plans and Subsidies

Individuals who choose bronze plan coverage can apply for premium tax credits (or premium subsidies). This is because premium tax credits are available to anyone whose household income is at or up to four times the Federal Poverty Level (FPL). However, bronze plans are not eligible for cost-sharing reduction (CSRs) subsidies. In order to use CSRs, you must first be within a certain income amount (up to 250 percent of the FPL). Then, you have to sign up for coverage with a silver (metal level) plan.

How Much Is the Bronze Plan?

For 2019, the average bronze plan costs $339 in monthly premiums. Below are the lowest-cost bronze plans by state for 2019:

Lowest-Cost Bronze Plans by State, Estimated Before and After Premium Tax Credits, in 2019
State Major City That Determined Rating Before Premium Tax Credit After Premium Tax Credit
Alabama Birmingham $327 $8
Alaska Anchorage $461 $0
Arizona Phoenix $333 $113
Arkansas Little Rock $320 $147
California Los Angeles $264 $87
Colorado Denver $336 $77
Connecticut Hartford $297 $75
Delaware Wilmington $450 $0
DC Washington $316 $136
Florida Miami $333 $92
Georgia Atlanta $316 $84
Hawaii Honolulu $361 $45
Idaho Boise $282 $10
Illinois Chicago $328 $151
Indiana Indianapolis $350 $179
Iowa Cedar Rapids $429 $0
Kansas Wichita $375 $52
Kentucky Louisville $275 $111
Louisiana New Orleans $336 $159
Maine Portland $335 $57
Maryland Baltimore $298 $85
Massachusetts Boston $252 $137
Michigan Detroit $225 $98
Minnesota Minneapolis $238 $144
Mississippi Jackson $474 $138
Missouri St Louis $325 $110
Montana Billings $321 $5
Nebraska Omaha $473 $0
Nevada Las Vegas $292 $130
New Hampshire Manchester $303 $107
New Jersey Newark $279 $138
New Mexico Albuquerque $241 $107
New York New York City $421 $52
North Carolina Charlotte $361 $31
North Dakota Fargo $282 $94
Ohio Cleveland $264 $143
Oklahoma Oklahoma City $334 $0
Oregon Portland $296 $91
Pennsylvania Philadelphia $370 $111
Rhode Island Providence $215 $89
South Carolina Columbia $406 $9
South Dakota Sioux Falls $331 $89
Tennessee Nashville $346 $63
Texas Houston $286 $100
Utah Salt Lake City $271 $0
Vermont Burlington $426 $0
Virginia Richmond $379 $89
Washington Seattle $319 $142
West Virginia Huntington $474 $169
Wisconsin Milwaukee $372 $16
Wyoming Cheyenne $560 $0

Source: Kaiser Family Foundation Health Insurance Marketplace Calculator and 2019 data published by Health and Human Services.
Premium and tax credit estimates are based on rates for a 40-year-old non-smoker making $30,000 per year. 

Comparing Bronze Plans to Other Plan Categories (Metal Levels)

Including the bronze plan, there are 4 categories of ACA marketplace plans. The additional plan categories are also named after metals: silver, gold, and platinum. Because of the naming structure, these plan categories are often referred to as metal levels. Since you now know about bronze plan coverage, here is a brief description of the other metal levels:

  • Silver plans’ premiums are higher than bronze plans, but lower than the other two metal levels. In exchange for a slightly higher premium, the out-of-pocket costs are somewhat less than those of bronze plans. These plans are ideal for people who want a little more coverage than what’s offered by bronze health plans. Additionally, people who qualify for subsidies will find the most value in silver plans.
  • Gold plans have a high monthly premium in exchange for low out-of-pocket costs. The deductibles are usually low. These plans are ideal for people who regularly go to the doctor or use medical services.
  • Platinum plans have the highest monthly premiums and lowest out-of-pocket costs. The deductibles are usually very low. These plans are ideal for people who go to the doctor very often and want to know that most of their medical costs will be covered.

To see how the premiums of different metal levels compare, here are the average monthly premiums for the lowest-cost plan in each of metal levels in 2019:

Plan Type Monthly Premium
Bronze Plan $339
Silver Plan $452
Gold Plan $514
Platinum Plan To be determined

Actuarial Values Determine Metal Levels

When a marketplace plan is created by a health insurance company, it will fall into one of the four metal levels (platinum, gold, silver, and bronze). The metal level it falls into is determined by the actuarial value (AV) of that plan. An actuarial value is the average percentage of total costs that a plan will pay for covered benefits, taking into account deductibles, copays, coinsurance and out-of-pocket maximums. Each metal level has a different AV:

Plan Type AV
Bronze Plan 60%
Silver Plan 70%
Gold Plan 80%
Platinum Plan 90%

The Expanded Bronze Plan

A new plan type was introduced in 2018: the extended bronze plan. This plan has an average AV of 60 percent, but that number is allowed to range from 56 percent to 65 percent. The expansion that allows the coverage percentage to go beyond the average minimum and maximum percentages (-4 percent or +2 percent AV) gives this plan its name.

Bronze HDHP with HSA options

In addition to the expanded bronze plan, a bronze high-deductible health plan (HDHP) has been created. This health plan is ACA compliant and “will allow an enrollee to qualify for a tax-subsidized health savings account (HSA) under the Internal Revenue Code.” The plan is available in all states that have a federally facilitated marketplace.

Zero Premium Bronze Plans

If you are within a certain income level, you may find low-cost or free high-deductible bronze plans available in your area for 2019.This is because premium tax credits increased when the premiums for silver plans rose, while the premiums for other metal levels did not increase at the same rate. So, a premium’s tax credit (or subsidy), matched with a low-premium bronze plan may equal out to zero premium coverage. Subsidy eligibility is based on total household income and family size, and cost sharing for zero premium plans may be higher than for other available plans.

Ready to Enroll?

You now have an understanding of the bronze plan. If you’re ready to put that information to use and enroll in a health insurance plan, give 1 of our licensed health insurance agents a call. An agent can help you double check your coverage choices, choose a plan that works for you (and your family), and enroll. Give us a call at (800) 304-3414 or find an agent near you.


References

http://www.kff.org/health-reform/issue-brief/analysis-of-2015-premium-changes-in-the-affordable-care-acts-health-insurance-marketplaces/ | https://www.healthcare.gov/glossary/bronze-health-plan/ | https://www.healthcare.gov/choose-a-plan/plans-categories/ | http://www.nationalhealthcouncil.org/sites/default/files/NHC_Files/Pdf_Files/Summary_and_Benefits_Guide.pdf | http://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-part-2/ | https://www.kff.org/health-reform/state-indicator/change-in-average-marketplace-premiums-by-metal-tier | https://www.kff.org/interactive/subsidy-calculator/ | https://data.healthcare.gov/dataset/PY2019-Individual-Medical-Landscape/yhnw-u2e3 | https://www.qhpcertification.cms.gov/s/Plans%20and%20Benefits | https://www.federalregister.gov/documents/2016/12/22/2016-30433/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2018 |