From the Hotline: PPACA Levels of Coverage for State Exchanges

Question: Do you have an outline of the different coverage requirements for silver, bronze and gold as far as health care reform requirements?

Answer: In summary fashion, PPACA defines specific levels of coverage to be offered by the state exchanges. They are:

BRONZE LEVEL– A plan at the bronze level shall provide a level of coverage that is designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the benefit plan.

SILVER LEVEL– A plan at the silver level shall provide a level of coverage that is designed to provide benefits that are actuarially equivalent to 70 percent of the full actuarial value of the benefits provided under the benefit plan.

GOLD LEVEL– A plan at the gold level shall provide a level of coverage that is designed to provide benefits actuarially equivalent to 80 percent of the full actuarial value of the benefits provided under the benefit plan.

PLATINUM LEVEL– A plan at the platinum level shall provide a level of coverage that is designed to provide benefits that are actuarially equivalent to 90 percent of the full actuarial value of the benefits provided under the benefit plan.

Any reference to a bronze, silver, gold or platinum plan shall be treated as a reference to a qualified health plan providing a bronze, silver, gold or platinum level of coverage. PPACA authorizes the Secretary of HHS to develop guidelines that provide minimal variation in the actuarial valuations used in determining the level of coverage of a plan to account for differences in actuarial estimates.

The Kaiser Family Foundation has produced a useful white paper on what the actuarial values in the PPACA mean as it related to the tiers of health insurance coverage, including the actuarial estimates of plan designs meeting those thresholds in 2014 from an actuarial firm, Aon Hewitt and Towers Watson.  We thought that if you needed a deeper analysis of these options, KFF does a great job of breaking down all of the factors.  The while paper can be found at :  http://www.kff.org/healthreform/upload/8177.pdf.