Levels of plans in the Health Insurance Marketplace are bronze, silver, gold and platinum categories. They are based on how you and your insurance plan split costs. Categories have nothing to do with quality of care
Total costs include: premiums, the amount you pay for health insurance each month; deductibles, the amount you pay for services before your insurance plan starts to pay; copayments, a fixed amount you pay for a service after you’ve paid your deductible; and coinsurance, the percentage of costs you pay after you’ve paid your deductible.
Each category may include several types of plans and provider networks, like health maintenance organizations (HMOs) and preferred provider organizations (PPOs). The categories are:
- Insurance company pays 60 percent, you pay 40 percent
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles can be thousands of dollars a year
- Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
- Insurance company pays 70 percent, you pay 30 percent
- Moderate monthly premium
- Moderate costs when you need care
- Silver deductibles are usually lower than those of bronze plans.
- Good choice if: You qualify for “extra savings” or, if not, if you’re willing to pay a slightly higher monthly premium than bronze to have more of your routine care covered.
- Note: If you qualify for “extra savings” on your deductible, copayment, and coinsurance (sometimes called cost-sharing reductions) you must pick a silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you use a lot of care.
- Insurance company pays 80 percent, you pay 20 percent
- High monthly premium
- Low costs when you need care
- Deductibles are usually low
- Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a gold plan could be a good value.
- Insurance company pays 90 percent, you pay 10 percent
- Highest monthly premium
- Lowest costs when you get care
- Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
- Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.