Skip to main content

Important Message: We are pleased to report that pharmacy claims began processing again on 3/18/24. Please refer to this press release for details. Thank you for your patience as we navigated this issue. Information about the Change Healthcare outage can be found on the DVHA Pharmacy page. Visit https://dvha.vermont.gov/providers/pharmacy for more information.

Metal Categories

What are Metal levels?

Metal categories tell you how you and your plan split the cost of your health care. The quality of the coverage is the same for all plans. The amount of coverage costs are different for each metal level. Metal levels have nothing to do with the quality of care. The Affordable Care Act presents qualified health plans by their metal types.

There are four metal levels:

Platinum

  • The insurance company pays about 90% of costs. You pay the remaining 10%, on average. This means the plans have the highest monthly premium and the lowest costs when you get care.

Gold

  • The insurance company pays about 80% of costs. You pay the remaining 20%, on average. This means the plans have the high monthly premium and the low costs when you get care.

Silver

  • The insurance company pays about 70% of costs. You pay the remaining 30%, on average. This means the plans have the moderate monthly premium and the moderate costs when you get care.
  • If you qualify for cost-sharing reductions (CSRs), look at enhanced silver plans. These plans may offer good value. If you qualify, your deductible will be lower, and you'll pay less each time you get care. But you get these extra savings only if you enroll in Silver.

Bronze

  • The insurance company pays about 60% of costs. You pay the remaining 40%, on average. This means the plans have the lowest monthly premium and the highest costs when you get care.

To pick your metal level, consider how much you think you will use your health care. If you expect to use a lot of health care, it might be less expensive in the long run to get a plan that covers more of your medical expenses.

Your premium can be lower, based on your income

You can save a lot of money on your monthly premium based on your income, no matter which metal level you choose. When you apply, you'll find out of you qualify for these savings.

You may be eligible for Advanced Premium Tax Credits (APTC), You can use these credits to lower your premium during the plan year. 

If you are eligible for APTC, you can choose to take the credit each month to lower your healthcare premium. You can decide to take a part of the credit each month. You can also wait and take the entire credit when you file your taxes.

The amount of APTC you can get depends on things like your income and household size. You must apply for healthcare through Vermont Health Connect to get APTC. Use the Plan Comparison Tool to find out the amount of tax credits your can get.

Consumer-driven (CDHP) v. High-deductible (HDHP) Health plans

Enter your basic information into the Plan Comparison Tool. Next, it will offer you a list of available plans. Options may include the acronym CDHP or HDHP. The Consumer-driven Health Plan (CDHP) and the High-deductible Health Plan (HDHP) generally have higher deductibles and lower monthly premiums, meaning you must pay your medical costs before your health plan does.