The Affordable Care Act (ACA) introduced metal levels to simplify selecting a health insurance plan. These levels (Bronze, Silver, Gold, and Platinum) indicate the cost-sharing split between insurance providers and policyholders.
- Bronze: Bronze plans generally have the lowest monthly premiums but the highest out-of-pocket costs. They’re best if you want to protect yourself from worst-case scenarios but expect little medical care throughout the year.
- Silver: Silver plans balance monthly premiums and out-of-pocket costs. They are a good option if you are willing to pay slightly higher premiums for lower costs when you get care.
- Gold: Gold plans have high monthly premiums but lower out-of-pocket costs. They are a suitable choice if you expect a lot of doctor visits or need frequent medical care.
- Platinum: Platinum plans represent the highest level of coverage, with the highest monthly premiums and lowest out-of-pocket costs. They are optimal if you require a lot of care and are willing to pay a high premium, knowing nearly all other expenses will be covered.
Remember, the right level depends on your specific health needs and financial circumstances. Reviewing each plan’s details carefully and consulting a professional is essential. You can find more information about each level below.
Bronze Plan Health Insurance
Bronze plans usually have the lowest monthly premium. However, they have the highest out-of-pocket costs for consumers. Because of the high out-of-pocket costs, these plans are ideal for those anticipating fewer medical services each year. Preventative care checkups and prescription drugs are part of the medical services covered under Bronze Metal insurance plans. Still, the consumer will be responsible for up to 40% of those expenses on a Bronze plan.
Bronze plans include:
- Lowest monthly premium
- Highest deductible
- Out-of-pocket savings for those with fewer annual healthcare needs
Silver Plan Health Insurance
Silver plans offer a balance between monthly premiums and out-of-pocket costs. Because they provide a lower out-of-pocket cost and increased cost-sharing with insurers, Silver plans are a popular choice for many individuals and families. Silver plans still cover many basic medical services like preventative health screenings and prescription drugs. When upgrading to a Silver plan, the out-of-pocket cost drops to 30% rather than 40% with the Bronze plan.
Additionally, depending on family size and household income, Silver plans offer premium tax subsidies and access to cost-sharing reductions (CSRs). Based on meeting qualifications, CSRs help lower out-of-pocket costs for care.
Silver plans include:
- Moderate monthly premium
- Lower deductible
- Cost-sharing reductions
Gold Plan Health Insurance
Gold plans have a higher monthly premium than Silver plans, but consumers are only responsible for up to 20% of covered medical expenses. Gold plans are ideal for those needing frequent medical services. They have access to all the same benefits, but the insurer shares more in the cost of care.
Gold plans include:
- Higher monthly premium
- Lower deductible
- Lower out-of-pocket costs for frequent healthcare needs
Platinum Plan Health Insurance
Platinum plans offer the lowest out-of-pocket costs but require the highest monthly premium. Platinum plans are the most beneficial to those who need consistent medical care. With a Platinum plan, consumers receive the same benefits as the other tiers but are only responsible for up to 10% of covered expenses.
Platinum plans include:
- Highest monthly premium
- Lowest deductible
- Coverage for a majority of healthcare costs
Do The Metal Levels Offer Different Benefits?
Regardless of metal level, all metal levels cover the same essential services:
- Outpatient or ambulatory services
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive services
- Pediatric services
While all metal level plans provide the same essential health benefits, adult members have the option to add dental and vision insurance for more complete coverage.
Meeting Your Healthcare Needs
Understanding your and your family’s healthcare needs is the first place to start when choosing an insurance plan. Consider age, upcoming medical procedures, and the cost of any regularly prescribed medications or appointments. Look at itemized bills from past medical expenses to get an idea of the out-of-pocket cost on each level.