Health Plan Categories

Health Plan Categories

Fri, 02/14/2020 - 16:34

Plans in the Marketplace are primarily separated into 4 health plan categories — Bronze, Silver, Gold, or Platinum — based on the percentage the plan pays of the average overall cost of providing essential health benefits to members.

♦ The plan category you choose affects the total amount you'll likely spend for essential health benefits during the year.

The percentages the plans will spend, on average, are 60% (Bronze), 70% (Silver), 80% (Gold), and 90% (Platinum). This isn't the same as coinsurance, in which you pay a specific percentage of the cost of a specific service.

How you and your insurance plan split costs, for each metal category —

Plan Category Insurer Pays You Pay
Bronze 60% 40%
Silver 705 30%
Gold 80% 20%
Platinum 90% 10%

• Generally, plans in the Bronze category have the lowest premiums but the highest deductibles and other out-of-pocket costs.

• Platinum plans generally have the highest premiums but the lowest deductibles and other out-of-pocket costs.

♦ If you qualify for cost-sharing reductions based on your income and enroll in a Silver plan, you can get the best of both worlds:

A fairly low premium, plus a lower deductible and other out-of-pocket costs.

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