Bronze, Silver, Gold, and Platinum plans for small groups

For an employer buying small-group coverage, including SHOP coverage, metal tier is one of the choices on the quote, alongside network design and funding structure.

What it is

Under 45 CFR 156.140, a Bronze plan is designed so the plan's share of expected allowed costs is 60 percent, Silver 70 percent, Gold 80 percent, and Platinum 90 percent. HealthCare.gov presents the same figures and notes that actual costs vary by plan, and that deductibles are generally higher at Bronze and lower at Gold and Platinum.

Those percentages are design targets, not a promise of what any one employee will pay in a given year. Two Gold plans can have different deductibles, copayments, and networks and still sit in the same metal category.

A health insurance issuer offering coverage in the individual or small-group market must include the essential health benefits package in each of these categories. Adult dental and vision are not required essential health benefits and are often added as group dental and vision or other voluntary benefits.

Cost-sharing reductions that make a Silver Marketplace plan richer for some individual enrollees are an individual-market rule. They do not carry over to a small-group employer plan.

The percentages in the regulation are targets. Issuers file a metal level for each plan, and a limited de minimis variation around the target is allowed under the applicable CMS rules. We will use the metal level the issuer has filed, and we will not restate a de minimis band on this page that we have not checked against the current regulation.

Small-group premiums are also subject to modified community rating. Under the federal defaults, a premium may vary only by whether the coverage is for an individual or a family, rating area, age, and tobacco use. The rate may not vary by health status. Some states use tighter age or tobacco ratios, or allow composite (average) enrollee premiums. That is why a small-group quote is built from the roster, ages, family tiers, and principal work location, not from the group's claims history in the way a large-group or self-funded arrangement might be.

Who it fits

Metal tiers are a fit for any employer shopping in the insured small-group market, because that is how those products are built. A company may offer one tier, or more than one, depending on what the issuer will write and on how you want to share cost with employees.

Large-group insured plans and self-funded plans are generally not required to use metal tiers. For an applicable large employer, the related federal test is minimum value — a plan share of at least 60 percent of total allowed costs, plus substantial coverage of inpatient hospital and physician services.

How it works for employers

You review a quote that lists each available plan's metal tier, network design, deductible, and employee contribution. Employees then enroll in one of the plans you have chosen to offer. The same group can often compare a Bronze or Silver HDHP with a Gold or Platinum plan that uses a lower deductible.

A small-group Bronze plan is not automatically HSA-qualified. It has to meet the IRS HDHP deductible and out-of-pocket tests in Internal Revenue Code § 223. A different rule treats certain bronze and catastrophic plans offered as individual coverage through an Exchange as HDHPs for months beginning after December 31, 2025. That rule does not, by itself, convert a small-group Bronze policy into an HDHP.

How it compares

Bronze, Silver, Gold, and Platinum are points on the same scale: as the plan's target share of expected costs rises, the enrollee's target share falls. Each tier is a legitimate fit for some groups. Network design — PPO, HMO, EPO or POS — is a separate choice. We will not describe a lower metal tier as cheaper in the abstract, because premium, deductible, and employer contribution all move together.