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health insurance metal tiers

What do the metal tiers behind your insurance plan mean?

Looking for the best individual insurance plan out there for you and not sure where to start? Whether you are looking for a qualified health plan to complement your company's ICHRA, or a MEC plan to go with a QSEHRA, or it's just simply open enrollment, we know it can be confusing sorting out all the insurance jargon and metallic color coding. This post should help! 

As with most things in life, “you get what you pay for,” and that rings true with health insurance. More expensive plans cover the majority of bills, leaving you with the lowest out-of-pocket costs, while less expensive plans have a lower percentage of bills covered by insurance. Of course, it’s not that cut-and-dry. Perhaps the most important question to ask yourself is, “How often are we going to need doctors/medical care?”

Decoding the metal tiers of health insurance 


  • You rarely get sick or need medical services, apart from an annual checkup and maybe a medication or two.
  • You are very healthy and not elderly.
  • If buying a family plan, your children are grown and healthy and don’t participate in risky activities.  
  • Expect to pay 40% out of pocket, 60% paid by your plan


  • Your family members have one or two mild conditions that require some medication and specialist visits, but nothing needing close monitoring or frequent care.
  • Your family members are able-bodied and under 70.
  • Any kids are elementary age or older and healthy, and play few or no sports that often cause injury.
  • Expect to pay 30% out of pocket, 70% paid by your plan


  • You or a family member has a chronic condition, sees doctors frequently or needs expensive medication that would be impossible to afford out of pocket.
  • Your children are preschool age or younger, needing frequent pediatrician visits.
  • You may be older or at a higher risk for colds and flu than most people.
  • Expect to pay 20% out of pocket, 80% paid by your plan


  • You or a family member has an expensive chronic condition and takes several medications.
  • You seek urgent or emergency care more than once per year on average, frequently need exams to manage a condition or see doctors more than once per month.
  • You are older or at very high risk for colds, flu, or injuries.
  • Expect to pay 10% out of pocket, 90% paid by your plan

Of course, no one can predict the future, so it might be hard to feel confident in your choice.

If you know a family member has an upcoming surgery, or might become pregnant soon, it might be a good idea to choose a more expensive plan. If it’s most important to keep out of pocket costs low, the lower tier plans might be best for you.

It’s tempting to want to stick with one plan out of convenience, and the thought of trying something new can be intimidating. Unfortunately, health insurance isn’t something that should be put on auto-pilot. Plans, doctor networks, prescription coverage and your family’s health needs are changing every year.

Take Command can help

We're here to help you navigate the world of health insurance! We've got a ton of resources available, including pretty much everything you need to know about shopping for plans on your own. But we are also here to answer your questions. Reach out if we can help! 


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