When comparing different metal insurance plans, consider the kind of health coverage you and your family need and how it will fit within your overall budget.
Bronze Plan Health Insurance
Bronze plans typically have the lowest monthly premium, but the highest out-of-pocket costs for care. These plans are ideal for individuals and families who are generally healthy and don't anticipate needing many medical services throughout the year. Bronze metal insurance plans are required to cover essential health benefits, such as preventive care services like check-ups and prescription drugs. You will be responsible for up to 40% of covered medical expenses when you seek care with a Bronze plan. Bronze plans include:
Silver Plan Health Insurance
Silver plans offer a balance between monthly premium and out-of-pocket costs for care. Silver plans are a popular choice for many individuals and families, because they provide a higher percentage of cost-sharing with the insurer, while providing the same essential health coverage as Bronze plans.
One difference between Silver versus Bronze health plans is that you will be responsible for up to 30% of covered medical expenses rather than 40% with Bronze plans. Additionally, Silver plans are the only metal tier that offer access to cost-sharing reductions (CSRs) in addition to premium tax subsidies. If you qualify, CSRs help lower your out-of-pocket costs for care. Silver plans include:
Gold Plan Health Insurance
Gold plans have a higher monthly premium compared to Silver plans, but lower out-of-pocket costs for care. Gold plans are ideal for individuals and families needing frequent medical services and want their insurer to share more in the cost for care.
Gold plans cover the same essential benefits as the other metal tiers. The only difference is that you will be responsible for up to 20% of covered medical expenses. Gold plans include:
Platinum Plan Health Insurance
Platinum plans have the highest monthly premium, but the lowest out-of-pocket costs. These plans are best for those individuals and families who require ongoing medical care and want more predictable out-of-pocket costs.
With a Platinum plan, you receive the same benefits as the other tiers, but you will only be responsible for up to 10% of covered medical expenses. Platinum plans include:
Do The Metal Levels Offer Different Benefits?
All Covered California plans, regardless of metal level, cover the same 10 essential health benefits:
- Ambulatory patient services (office visits and other outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (surgery and overnight stays)
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative services and devices (used to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care for children
While all Covered California plans provide the same essential health benefits, adult members can choose to add dental and vision insurance to their plan for more complete coverage.
Bronze, Silver, Gold, & Platinum: Which Health Insurance Tier Is Best For Me?
When choosing between metal tiers, you should consider your and your family’s healthcare needs, budget, and ability to meet unexpected costs. Consider reviewing your healthcare expenses from the last 12 months to predict what level of coverage you may need this year, while keeping in mind that costs typically rise each year and emergencies or illnesses can happen at any time.
Meeting Your Healthcare Needs with Each Metal Plan
The most important factor to consider when comparing plans and costs is your healthcare needs and those of your family. You should factor in age, any upcoming medical care, and the cost of any regularly prescribed medications.
For example, if you and anyone else included in your health plan are healthy and don’t typically have many medical expenses or high-priced prescriptions, a lower-cost, high-deductible Bronze plan may be the best option. If you or someone on your plan is an older adult, has an ongoing condition or treatment, take several medications, or visit doctors and specialists frequently, then a Gold or Platinum plan with a higher monthly premium, but lower out-of-pocket costs for care, may be right for you.
Budgeting For Healthcare Costs
Next, consider your budget. How much can you afford to pay for your monthly premium and other health insurance costs? Do you qualify for premium tax credits or other cost-sharing reductions that reduce your out-of-pocket costs?
Also consider how much you could expect to pay for your deductible, co-pays, coinsurance, and other medical expenses under each plan. For example, if a Bronze plan fits your budget, but premium tax credits significantly reduce the monthly cost for a Silver plan and you qualify for CSRs, you may be able to reduce your overall out-of-pocket costs by choosing the Silver tier plan.
If you frequently use or require healthcare services, then choosing a Gold or Platinum plan with a higher monthly premium may reduce the chance for unexpected out-of-pocket costs throughout the year. However, if you qualify for the Silver tier CSR subsidies, carefully consider what your total out-of-pockets costs will be annually with the additional savings. A Silver tier plan may be the best plan, even if you have frequent healthcare needs.
Can You Afford Unexpected Healthcare Costs?
The last factor to consider is your ability to pay unexpected healthcare costs should they arise. If you only see a doctor for an annual check-up and don’t have any medical care needs, your monthly and annual out-of-pocket expenses can be budgeted in advance, but a visit to the emergency room could result in higher than expected, unplanned costs.
If you feel confident you could afford to cover up to 40% of the emergency room costs if you or your child required emergency care, then a Bronze plan could be a way to lower your monthly health plan expenses and offer you more budget flexibility. However, if your budget doesn’t allow for surprise medical costs, a Silver, Gold, or Platinum plan with a higher monthly premium that could reduce your share of the emergency room costs might be a better fit, especially if you qualify for subsidies to reduce your out-of-pocket costs as well.
Consider each of the cost-related factors mentioned above when choosing a health insurance plan.
What Savings Are Available For Each Metal Level?
Premium Tax Credits For All Metal Levels
Premium tax credits, also known as healthcare subsidies, are based on your household income and family size (including yourself, your spouse, and anyone you claim as a tax dependent — even if they do not need health coverage). Subsidies can be applied to your monthly premium for any metal level. If you qualify, you may be able to lower or completely eliminate your premium.
By factoring together premium tax credits, any additional cost-sharing reductions you may qualify for, and your projected healthcare needs for the next year, you will find the right metal level for your unique situation.
Silver Level Cost-Sharing Subsidies
While advanced premium tax credits are available for every metal level, cost-sharing reductions (CSRs) are only available when you choose a Silver plan. If you qualify, CSRs help lower your costs for care, including your deductible, copays, coinsurance, and out-of-pocket maximum.