What is the difference between bronze, silver, gold and platinum plans?
The metal level tells you how costs are split between you and the plan, not how good the care is. One level carries a discount the others do not.
- The metal level tells you how costs are split between you and the plan, not how good the care is.
- Bronze pays about 60 percent of costs across everyone enrolled, silver 70, gold 80 and platinum 90.
- Cost sharing reductions attach to silver plans only, so qualifying for them changes the comparison.
The metal level tells you how the bill is split between you and the plan. It says nothing about the quality of care, which doctors you can see, or the company behind the plan.
All four cover the same essential health benefits, the services every Marketplace plan must include. None can turn you down for a health problem you already have.
The four levels
- Bronze. The lowest premium, the monthly bill for the coverage, and the highest deductible, the amount you pay before the plan starts paying. It covers roughly 60 percent of costs across everyone enrolled.
- Silver. A moderate premium and a moderate deductible. Roughly 70 percent.
- Gold. A higher premium and a lower deductible. Roughly 80 percent.
- Platinum. The highest premium and the lowest deductible. Roughly 90 percent. Not offered everywhere.
Those percentages are the plan's share across everyone enrolled, not yours. What you pay depends on how much care you use.
Why silver is different
Cost sharing reductions attach to silver plans only. They are a discount the government puts on the deductible, the copays and the out of pocket maximum. A copay is the flat amount you pay at a visit. The out of pocket maximum is the ceiling on what you can pay in a year. If your income falls in the range that qualifies, those silver numbers drop, sometimes below a gold plan's. The discount does not follow you to another metal.
The premium tax credit, money the government puts toward your monthly bill, is figured against the second lowest cost silver plan in your area. That is why silver sits at the center.
Who each level suits
- Bronze. For someone who rarely sees a doctor and does not qualify for cost sharing reductions. Be sure you could pay the deductible.
- Silver. The one level that carries cost sharing reductions, so it matters most if your income falls in the range that qualifies.
- Gold. A higher monthly bill, much lower costs when you use care. Regular prescriptions, an ongoing condition or a planned procedure point here.
- Platinum. The highest monthly bill, the smallest share of costs left to you. For heavy expected use of care.
How to choose properly
- Find out whether you qualify for cost sharing reductions. They apply to silver plans only.
- Estimate the care you expect to use this year.
- For each plan, add twelve months of premium to the deductible. That is close to your cost in a moderate year.
- Add twelve months of premium to the out of pocket maximum. That is your worst case.
- Check your doctors against the plan's network, the doctors and hospitals it contracts with. Check your drugs against the formulary, its list of covered medicines.
- Compare those numbers rather than the metal names.
Catastrophic plans
A fifth category is open to people under 30, and to some with a hardship exemption. These plans carry a very low premium and a very high deductible. No premium tax credit can be applied to one.
Because the credit cannot be used, a bronze or silver plan with a credit often costs less over the year. Run the numbers before assuming a catastrophic plan is the low cost route.
Write down the twelve month figures for two or three plans, then check your doctors and drugs on each. Current deductibles and maximums are on healthcare.gov. To go through it with someone, call our McAllen office at (956) 687 3334, or use the ZIP form on this page.
Common follow-up questions
Is gold better care than bronze?
No. The metal level describes how costs are split, not the quality of care. Both cover the same essential benefits, though the network of doctors can differ.
Why do people say to pick silver?
Because cost sharing reductions apply to silver plans only. If your income falls in the range that qualifies, silver is the one metal where those discounts show up.
Can I change metal levels later?
Generally only during open enrollment, the yearly window when you can sign up or switch, or after a qualifying life event such as losing job coverage or moving.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.
