Affordable Care Act: Bronze, Silver, Gold, or Platinum Plans
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If you shop on the Health Insurance Marketplace for the insurance you’re required to carry under the Affordable Care Act (ACA), you’ll find that the plans available to you are labeled by type of metal: bronze, silver, gold, or platinum. (If you’re under age 30 or you’re unable to find coverage in the Marketplace that costs less than 8 percent of your income, you can also consider catastrophic plans.)
The metals represent various levels of coverage you receive and what the plan pays on average. The plan levels do not represent the quality of the health coverage you receive. The ACA requires that all Marketplace plans offer essential health benefits, including preventive and wellness care, at no additional charge to you.
While Marketplace plans certainly may differ from each other in the types of additional coverage offered, the metal designations are used strictly to highlight how you and the insurance company share costs for a plan — not to indicate the plan’s quality.
Here’s the rundown:
Bronze: If you buy into a bronze plan, you can expect to pay, in general, relatively low premiums, but out-of-pocket costs, in the form of copayments, coinsurance, and deductibles, are the highest among all four categories.
Bronze plans cover approximately 60 percent of healthcare costs, and individuals are responsible for approximately 40 percent. Therefore, a bronze plan likely makes most sense for someone who isn’t expecting to use health services often during the year.
Silver: A silver plan’s premium generally is higher than that of a bronze plan, and its out-of-pocket costs are lower. Silver plans cover approximately 70 percent of healthcare costs, and individuals are responsible for approximately 30 percent.
Gold: A gold plan’s premium generally is higher than that of a silver plan, and its out-of-pocket costs are lower. Gold plans cover approximately 80 percent of healthcare costs, and individuals are responsible for approximately 20 percent.
Platinum: A platinum plan’s premiums generally are the highest among the metal levels, and its out-of-pocket costs are lowest. Platinum plans cover approximately 90 percent of healthcare costs, and individuals are responsible for approximately 10 percent.
Whereas a bronze plan may make sense for a healthy person who anticipates needing little medical care, a platinum plan may make good sense for someone who expects to need ongoing and/or intensive health services.
How significant are the differences in premiums among the various metal plans? You can answer that question only by checking out your state’s Marketplace offerings; visit HealthCare.gov to get started.
Broadly speaking, you can pay up to a few thousand dollars more annually for premiums for a platinum plan than for a bronze plan. Is it worth the upfront expense to do so? That answer depends entirely on your healthcare needs and the out-of-pocket costs you may face if selecting a bronze plan.
The U.S. government has established financial subsidies to help individuals who purchase insurance via the online Marketplace. If your income qualifies for this assistance, you must enroll in a metal plan (not a catastrophic plan) to get a tax credit to help pay your insurance premiums.
If you qualify to reduce your out-of-pocket expenses as well, you must enroll specifically in a silver (midlevel) plan.