Even when a service or medication is covered, you may pay part of the cost. Learn how out-of-pocket costs like copays, coinsurance and deductibles work. (Video, 2:41)Open video transcript
Value standards across health plans
Our qualified health plans are ranked using metal tiers: Bronze, Silver, Gold and Platinum. Metal tiers help you compare health plans with similar actuarial value – the amount of costs covered by the plan. All plans within each metal tier include a monthly premium (the amount you pay each month for your coverage) and out-of-pocket costs when you get care (copays, coinsurance and deductibles), but the amounts differ across metal tiers.
Each tier provides an average percentage of coverage:
- Bronze: 60 percent
- Silver: 70 percent
- Gold: 80 percent
- Platinum: 90 percent
Bronze health plans usually have the lowest premiums and highest out-of-pocket costs – copays, deductibles and coinsurance. Platinum plans typically have the highest premiums and lowest out-of-pocket costs.
It’s impossible to predict all your health care needs for the year ahead. But we can help you choose a plan that fits your health insurance needs and budget.
- Platinum or Gold level plans may be a good idea if you make frequent doctor visits or need prescriptions on an ongoing basis.
- Silver plans cost a little less per month than platinum or gold plans and may be a better option if you don’t expect to use medical services or prescriptions very often.
- Bronze plans cost less per month in premiums but also pay less of your costs when you need care.
In addition to the four metal tiers, there is a catastrophic plan that can protect you from worst-case scenarios like serious accidents or illnesses. Catastrophic plans have much lower premiums and relatively high deductibles. Only people younger than 30 or those with “hardship exemptions” from the government can buy a catastrophic health plan.