What plan tiers can I quote, and how do I choose one for my client?
When you build a quote, you anchor it to one of four plan tiers. The tier tells the quoting tool which kind of individual health plan to use when it estimates premiums and suggests a contribution. Choosing the right tier is the biggest lever you have for matching a quote to what your client wants to offer.
Good to know: the tier is a benchmark for designing the budget. It doesn't limit employees. They can still use their allowance on any qualifying plan they choose.
The four tiers
| Tier | What the quote uses | Best for |
|---|---|---|
| Cost Saver (Bronze) | Low-premium Bronze plans still worth having | Clients focused on keeping cost down, or a younger, healthier team |
| Silver | Silver plans priced close to the lowest-cost Silver plan in each employee's area | Clients who want a middle-ground option tied to the marketplace's own benchmark |
| Gold Standard (Gold) | Low-cost Gold plans with comprehensive coverage | Clients who want strong coverage with lower out-of-pocket costs |
| Low-to-No Deductible | Plans with a $0 deductible, or close to it | Clients who want the most generous, predictable benefit |
The tiers are listed from leanest to richest coverage. Richer tiers usually mean higher premiums, so the same allowance covers less of the cost.
How each tier compares
Cost Saver (Bronze)
- Lowest premiums, highest deductibles
- Often narrower networks, frequently HMOs
- Stretches a tight budget the furthest while still giving employees ACA-compliant coverage
Silver
- Moderate premiums and deductibles
- Silver is the metal level the marketplace uses as its benchmark, so it's a familiar reference point for comparing ICHRA with what employees would see on their own
- Please note: Silver isn't always the cheaper middle option. Because of "silver loading," Silver plans can cost as much as, or even more than, Gold plans. How big the difference is depends on your client's market: their state, county and the insurers there. Check the average premium for Silver and Gold Standard in the quote, and if you're not sure, ask our team about Silver to see whether it's the best option for your client. Why do Silver plans sometimes cost as much as Gold?
Gold Standard (Gold)
- Higher premiums than Bronze or Silver, with lower deductibles and copays
- Often broader networks
- A strong anchor for comparison, and often better value than Silver
Low-to-No Deductible
- Highest premiums, with little or no deductible
- The most predictable out-of-pocket costs for employees
- Ideal for clients who want an easy-to-use, generous benefit
How the tier works in a quote
- Flat Rate: the tier sets which plans the quote is anchored to. The tool shows the average premium for each tier, and the contribution strategies suggest an allowance as a percentage of that average.
- Smart Rates: the tier is the benchmark. Each employee's allowance is a set percentage of their own premium for that tier, based on their age and ZIP code (for example, 75% of Silver). See How are Smart Rates calculated?
You can switch tiers at any time while building a quote, and the estimates update right away.
How to choose the right tier for your client
- Start with the budget. If your client has a fixed amount to spend, start with Cost Saver or Silver so the allowance covers a meaningful share of each employee's premium.
- Match the client's goal. Keeping cost down? Cost Saver. Replacing a group plan with similar coverage? Gold Standard. Recruiting and retention? Low-to-No Deductible.
- Think about the team. Older employees, families or people who see doctors often usually get more value from Gold Standard or Low-to-No Deductible. Younger, healthier teams often do fine with Cost Saver.
- Compare Silver and Gold side by side. Because of silver loading, Gold Standard sometimes costs about the same and covers more.
- Use the quote's suggestions. The quote's fit score and recommendations flag when the budget could stretch to a richer tier, or when Cost Saver would make the same budget go further.