What Are Health Plan Categories?

What Are Health Plan Categories?

I'm here to break down the four health plan categories offered through the U.S. federal government's Health Insurance Marketplace: Bronze, Silver, Gold, and Platinum. These categories are straightforward—they're defined by the percentage of expenses each plan type covers on average.

Key Takeaways

In the U.S., you'll find health insurance Marketplace plans in four levels: Bronze, Silver, Gold, and Platinum. Gold and Platinum plans cover more of your healthcare expenses on average, while Silver and Bronze cover less. There's also catastrophic coverage for people under 30 or anyone who qualifies for a hardship exemption.

How Health Plan Categories Work

These categories are all about how costs are split between you and your plan. On average, Bronze plans have you paying 40% while the insurer pays 60%, Silver is 30% you and 70% insurer, Gold is 20% you and 80% insurer, and Platinum is 10% you and 90% insurer.

Take a $100 doctor visit as an example—after meeting your deductible, you'd pay about $40 on a Bronze plan, but only $10 on Platinum. Remember, all these plans cover the same essential health benefits like emergency services, hospitalization, maternity care, mental health, prescription drugs, and more, just at different percentages. They all include free preventive services such as vaccines and cancer screenings.

When you apply on the Healthcare Marketplace or your state's version, you can compare specifics from each insurer. You'll see variations in deductibles, copayments, and coinsurance. For instance, one plan might have a high deductible like $4,000 with low 10% coinsurance, while another has a $1,500 deductible but 30% coinsurance.

Premiums are key too—you pay them monthly regardless of usage. They're usually higher for Gold and Platinum since they cover more when you need care, and generally higher for plans with lower deductibles and coinsurance.

Beyond the metal tiers, catastrophic plans are an option if you're under 30, or over 30 with an income-based hardship exemption or other qualifying circumstances that prevent you from affording a standard plan.

Types of Health Plan Categories

It pays to compare these categories before picking one. For example, special financial assistance is often only available with Silver plans. Overall, you're weighing monthly premiums against your expected care needs for the year.

Bronze Health Plan Category

Bronze plans are the second most popular choice on the Marketplace—about one-third of people picked them in 2023, per Kaiser Family Foundation research. They offer the lowest monthly premiums, averaging $342 nationwide for the cheapest options, which is great if you're budgeting.

But expect high out-of-pocket costs for routine or emergency care—deductibles can run into thousands, and even after that, copays and coinsurance are higher. Still, it's a solid way to avoid financial ruin from big medical bills, and you get free preventive care plus essential benefits just like other plans.

Silver Health Plan Category

Silver is the top pick, with around 54% choosing it in 2023 according to Kaiser. Premiums are higher than Bronze—averaging $448 for the lowest nationwide—but you pay less out-of-pocket overall, with lower deductibles too.

If you qualify for cost-sharing reductions based on income and household size, you have to go with Silver to use them—they're only for this tier.

Gold Health Plan Category

Not many opt for Gold—only about 12% per Kaiser, likely due to higher premiums averaging $472. But when you need care, you only pay about 20% out-of-pocket, with lower deductibles. It's a smart choice if you see providers often or worry about high costs.

Platinum Health Plan Category

Platinum is the top tier, but rare— just 1% choose it. Premiums are the highest, but you pay only 10% out-of-pocket with the lowest deductibles. If you know you'll need frequent doctor visits, the high monthly cost might be worth the near-full coverage.

What is the Cheapest Health Plan Category?

Bronze is typically the cheapest with you paying 40% and the insurer 60%, but check if you qualify for catastrophic plans or Silver with reductions for even lower effective costs.

Who Qualifies for a Catastrophic Health Plan?

You can get a hardship exemption for reasons like homelessness, major property damage from disasters, or recent bankruptcy—there are 14 such qualifiers allowing catastrophic coverage over age 30.

What Are the Four Categories of Expenses a Health Care Policy Owner May Pay?

Your out-of-pocket costs might include deductibles, copayments, coinsurance, and anything not covered, plus your monthly premium.

The Bottom Line

These categories give you options on the Marketplace to match your budget and expected needs. I recommend talking to a licensed broker, agent, or assister to pick the right one.