Understanding Health Insurance Metal Levels

When comparing metal levels, consider the kind of health coverage you and your family need and how it fits your budget.

Bronze Plan Health Insurance 

Bronze plans typically have the lowest monthly premiums, 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 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 your medical expenses when you seek care with a Bronze plan. Bronze plans offer:

 Lowest monthly premiums

 Highest deductible

 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 for care. These plans are a popular choice for many individuals and families, because they provide a higher percentage of cost-sharing from the health plan at a reasonable price.

Silver plans provide the same essential health coverage as Bronze plans, and you will be responsible for up to 30% of your medical expenses. Additionally, Silver plans are the only metal tier that offer 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 offer:

 Moderate monthly premiums

 Lower deductible

 Cost-sharing reductions based on family size and household income

Gold Plan Health Insurance  

Gold plans have higher monthly premiums than Silver plans, but lower out-of-pocket costs for care. These plans are ideal for individuals and families needing frequent medical services and want more comprehensive cost coverage.

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 your medical expenses. Gold plans offer:

 Higher monthly premiums

 Lower deductible

 Lower out-of-pocket costs for frequent healthcare needs

Platinum Plan Health Insurance 

Platinum plans have the highest monthly premiums, 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 monthly costs.

With a Platinum plan, you receive the same benefits as the other plans, but you will only be responsible for up to 10% of your medical expenses. Platinum plans offer:

 Highest monthly premiums

 Lowest deductible

 Coverage of many healthcare costs

Compare your projected monthly costs and budget to choose a health insurance plan that’s best for you.

Do The Metal Levels Offer Different Benefits?

No. All Health Insurance Marketplace plans, regardless of metal level, cover the same 10 essential health benefits:

1. Ambulatory patient services (office visits and other outpatient care you get without being admitted to a hospital)
   
   
2. Emergency services
   
   
3. Hospitalization (surgery and overnight stays)
   
   
4. Pregnancy, maternity, and newborn care 
   
   
5. Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
   
   
6. Prescription drugs
   
   
7. Rehabilitative services and devices (used to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
   
   
8. Laboratory services
   
   
9. Preventive and wellness services and chronic disease management
   
   
10. Pediatric services, including oral and vision care for children
     

While all Marketplace plans provide the same essential health benefits, you can choose to add dental and vision insurance to your plan for adult members at an additional cost.

Bronze, Silver, Gold, & Platinum: Which Health Insurance Tier is Best for Me?

When choosing between metal tiers, you should consider your personal and family healthcare needs, budget, and ability to meet unexpected costs. Consider reviewing your healthcare expenses for the last 12 months to predict what 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 own healthcare needs, and those of your family. You should factor in your ages, any upcoming medical needs, and the cost of your 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, then a lower-cost, higher-deductible Bronze plan may be the best option. If you’re an older adult, have a chronic illness, take several medications, or see doctors and specialists frequently, then a Gold 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? Do you qualify for tax credits or other cost-sharing reductions that reduce your monthly premium and out-of-pocket costs for care?

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 the Bronze plan fits your budget, but premium tax credits significantly reduce the cost of the Silver plan, 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 your variable out-of-pocket costs throughout the year. 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 emergencies, 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 could afford to cover up to 40% of the emergency room costs if your child required emergency care, then a Bronze plan could be a way to lower your monthly recurring expenses and offer you more budget flexibility. However, if your budget doesn’t allow for surprise medical costs, a Gold 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 monthly premium costs as well. 

What Savings Are Available for Each Metal Level?

Silver Level Cost-Sharing Subsidies

Cost-sharing subsidies, or CSRs, are available based on your household income, and help lower out-of-pocket costs like your deductibles, copays, and coinsurance. CSRs are available only when you choose a Silver plan. 

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, if married, 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 among the marketplace health insurance plans available in your area.