Understanding Silver Plan Health Insurance

What is an ACA Silver Health Plan?


A Silver healthcare plan is a specific type of health insurance plan offered through the Marketplace, established by the Affordable Care Act (ACA), also known as Obamacare. The ACA introduced affordable health insurance plan options available to individuals and families who purchase their own coverage.


The Marketplace uses metal levels to categorize plans. There are four plan levels available: Bronze, Silver, Gold, and Platinum. Each metal level offers the same essential health benefits but differs in the percentage of costs your insurer pays versus what you pay for care. These cost-sharing differences allow you to choose a plan that best aligns with your unique healthcare needs and budget.


Silver plan health insurance is a popular option, designed to strike a balance between affordability and coverage. Silver plans are the only metal level plans that include unique cost-sharing opportunities to help further lower out-of-pocket costs for members who qualify. While you have a slightly higher monthly premium with a Silver plan than a Bronze plan (you are responsible for 30% of the costs for care and the insurer covers 70%), you’ll pay less out-of-pocket when you need care—and cost-sharing reductions can help lower those costs even more. This article will further explore health insurance subsidies below.

Benefits of Silver Healthcare Plans


All metal level plans, including Silver plans, must cover essential health benefits mandated by the ACA, including:

  • Ambulatory patient services (outpatient care received 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 regain or recover mental and physical skills due to injuries, disabilities, or chronic conditions)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

In addition to the essential health benefits, Wellpoint Silver plans include added enhanced benefits like $0 for commonly used prescription drugs and $0 virtual care visits. 1, 2


It's also important to review the specific details of the Silver plans offered by each of the insurers you're considering. For example, each plan and insurer may offer access to a different network of doctors and hospitals for care.



Understanding the Average Cost of a Silver Health Plan


The cost of a Silver health insurance plan varies depending on various factors, including your age, location, income, tobacco use, and family size. It’s also important to note that if you enroll in a Silver plan, you may qualify for cost-sharing reductions (CSRs) that can further reduce overall costs associated with your deductible, copays, coinsurance, and out-of-pocket maximum.


Before exploring how CSRs can help reduce the average cost of Silver health plans, it will help to better understand how those costs break down.

  • Premium: Your monthly payment to your insurer to maintain coverage. Silver plan premiums are higher than those for Bronze plans, but lower than those for Gold or Platinum plans. A plan with a higher monthly premium typically means you’ll have a lower deductible, lower copays, and a lower out-of-pocket maximum.
  • Deductible: The amount you must pay out-of-pocket for care before your insurer starts to pay. Silver plans usually have a moderate deductible, meaning it is higher than Bronze plans, but lower than Gold or Platinum plans. 
  • Copays: A fixed amount you pay your care provider for each visit.
  • Coinsurance: The percentage of costs you pay for care after meeting your plan’s deductible. The Silver plan’s coinsurance structure means that you pay 30% for the cost of care, and your insurer pays 70%.
  • Out-of-pocket maximum: The most you pay for your healthcare expenses annually. Once you reach the maximum, your insurer covers 100% of eligible healthcare costs for the rest of the plan year. The out-of-pocket maximum varies depending on the specific plan and insurer. However, under the ACA, there are annual limits on the in-network, out-of-pocket maximums for Marketplace plans, including Silver plans. These limits are adjusted every year. The Centers for Medicare & Medicaid Services state that for the 2025 plan year, “the out-of-pocket limit for a Marketplace plan cannot be more than $9,450 for an individual and $18,900 for a family.” 3



Cost-Sharing Reductions for Silver Plan Health Insurance


As mentioned above, Silver health insurance plans are unique among the four metal levels because they offer cost-sharing reductions (CSRs), which is financial help that lowers out-of-pocket costs for care. CSRs are one of two forms of health insurance subsidies provided under the Affordable Care Act to help eligible individuals and families afford health insurance.


The other type of subsidy is the advanced premium tax credit (APTC), which qualified consumers can use to reduce or eliminate their monthly plan premium. CSRs, on the other hand, can help consumers further reduce their out-of-pocket costs including their plan deductible, copays, and coinsurance, and out-of-pocket maximum. While APTCs are available across all metal levels, CSRs are only available through a Silver plan. It is also possible to qualify for both CSRs and advanced premium tax credits.


To qualify for CSRs, you must meet the following criteria:

  • Enroll in a Silver metal level plan through the Health Insurance Marketplace.
  • Meet the income requirements (250% or less than your state’s federal poverty level). 
  • Must not be eligible for Medicaid or Medicare. 

When you enroll in a Silver plan and qualify for CSRs, your insurer will automatically apply the savings to your plan. This means that your deductible, copays, coinsurance, and out-of-pocket maximum will be lower than they would be for someone who does not qualify for CSRs.


For example, if you have a Silver plan with a $3,000 deductible and you qualify for CSRs, your actual deductible may now be $1,500. This means that you would only have to pay $1,500 out-of-pocket before your insurer starts paying for covered medical expenses.



Comparing ACA Silver Health Plans with Bronze, Gold, and Platinum Levels


Choosing a Silver plan comes with its advantages, but it’s also important to review various factors, including affordability, coverage flexibility, and potential limitations to make an informed decision for you and your family. 


When considering any insurance plan, evaluate your and your family’s anticipated care needs, budget, and eligibility for financial help.


Silver plan health insurance is generally considered the most balanced metal level in terms of cost and coverage. Consider the below chart to see how you and your insurer will share the cost of care across each level:






What Your Plan Pays:





Your Cost:





Your unique healthcare needs can play an important role in determining your health insurance costs. Your premium is a fixed amount that you must pay every month, so if you rarely visit your doctor and do not have routine prescription costs, you may be comfortable paying more when you need care if it means a lower monthly premium.  


Silver health plans are often a good option for people who are willing to pay a higher premium than a Bronze plan in return for more manageable out-of-pocket cost-sharing with their insurer when receiving care. Here are two situations where an individual or family may benefit from a Silver plan:


Those who need to balance their annual healthcare costs: Silver plans strike a balance between a plan’s monthly premium and out-of-pocket costs for care. They may make sense if you or your family have moderate healthcare needs throughout the year.


Those eligible for cost-sharing reductions (CSRs) based on income: Individuals and families who qualify for CSRs may find a Silver plan particularly appealing. CSRs reduce out-of-pocket costs for care, often making a Silver plan more affordable overall than a Bronze plan. While Bronze plans have a lower monthly premium, CSRs are not available to help lower out-of-pocket costs. Despite a slightly higher premium, Silver plans often become more affordable in the long run because of the additional out-of-pocket savings CSRs offer, which you cannot access with any other type of Marketplace plan.

Anthem Can Help You Decide if a Silver Health Plan is Right for You

Choosing a Silver health plan can be an excellent option if you’re looking for a balance between your monthly premium and out-of-pocket costs for care, especially if you qualify for cost-sharing reductions. Anthem is here to help you navigate your options and find the best health insurance plan to suit your needs and budget.

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Frequently Asked Questions About ACA Silver Plans



What is a Silver healthcare plan?


A Silver plan is one tier of health insurance plans available through the Marketplace, covering all the essential health benefits mandated by the ACA and provides a more balanced cost-sharing structure (a moderate monthly premium with more manageable out-of-pocket costs for care).


How much does a Silver health plan cost?


The overall cost of a Silver health insurance plan varies depending on various factors, including your age, location, income, tobacco use, family size, and eligibility for an advanced premium tax credit and cost-sharing reductions.


Who should consider a Silver plan?


Silver plans may be a good option for people who are more comfortable with a higher monthly premium than a Bronze plan in exchange for more manageable out-of-pocket costs for healthcare services.

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1 Some commonly-used prescription drugs are available at no cost to you. Contact us for more information.


2 Virtual care visits, including medical chats and video visits using the Sydney Health app are at no cost to members for most plans. Those enrolled in High-Deductible Health Plans associated with a Health Savings Account and Catastrophic plans must first meet their deductible. Virtual care visits refer to medical chats and/or video consultation, as deemed appropriate by a licensed physician.


In addition to using a telehealth service, you can receive in-person or virtual care from your own doctor or another healthcare provider in your plan’s network. If you receive care from a doctor or healthcare provider not in your plan’s network, your share of the costs may be higher. You may also receive a bill for any charges not covered by your health plan.


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