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Understanding Health Insurance Metal Levels
Understanding Health Insurance Metal Levels
April 17, 2025 | 6 min read
Marketplace health insurance plans are categorized into four metal tiers: Bronze, Silver, Gold, and Platinum. This makes it possible to compare plans from different providers when shopping on the exchange. Each tier offers different levels of cost-sharing between the insurer and the insured.
What are the Metal Levels?
Bronze plans typically have the lowest premiums but the highest deductible and out-of-pocket costs, making them suitable for individuals who don't expect to use many medical services. Silver plans strike a balance, offering moderate premiums and out-of-pocket costs, and are often eligible for cost-sharing reductions for those who qualify. Gold plans have higher premiums but lower out-of-pocket costs, making them a good choice for those who anticipate more frequent medical needs. Platinum plans have the highest premiums but the lowest out-of-pocket costs, providing the most comprehensive coverage for those who require extensive medical care.
It's important to note that the key difference between the metal levels is in how costs are shared, not the quality of care.
Plan Category | Plan Pays | You Pay | Deductible | Premium |
|---|---|---|---|---|
Bronze | 60% | 40% | High | Low |
Silver | 70% | 30% | Moderate | Moderate |
Gold | 80% | 20% | Low | High |
Platinum | 90% | 10% | Low | High |
How to Choose the Metal Level that Meets Your Needs
Plan Costs
The key to finding the best metal tier for your needs is to find the right balance between the monthly premium and your anticipated healthcare usage. The plan may have a low premium, but if you expect to use your healthcare for more than just routine visits, you may end up paying more out-of-pocket in the long run.
The total cost of your healthcare involves not just your premium and deductible, but the level of cost sharing your plan provides when you see your provider. Shop and compare plans to see details of multiple plans side-by-side, including premiums, deductibles, maximum out-of-pocket costs, and an estimated all-in figure to find the best fit for you.
Premium Tax Credits
Don’t forget to factor in the possibility of premium tax credits when you shop for health insurance. Premium tax credits are a form of financial assistance provided by the government to help individuals and families afford Marketplace health insurance. If your income falls within a certain range, you may be eligible for these credits, which can be applied directly to your premium costs to make health insurance more affordable.
Cost Sharing Reductions
Another way to save on your health insurance costs is through a Cost Sharing Reduction, or CSR. The CSR is available only for people who select a plan in the Silver category and have household incomes under a certain level. People who qualify for a CSR will typically have a lower deductible, lower copayments and a lower out-of-pocket maximum.
Network of Providers
It’s also important to consider the network of providers covered by each metal tier. A broader network offers more doctors and hospitals, giving you more options for care and making it less likely you have to see an out-of-network provider at a higher cost. A narrower network is more limited, so be sure to find out if your preferred providers are included if you have them.
Are you ready to find an affordable health insurance plan to meet your needs and budget? Shop our plans today, or call our helpful team at 844-933-0380 (TTY: 711) from 8 a.m. to 9 p.m. ET.
Questions about the Health Insurance Metal Levels
All plans offered on the Health Insurance Marketplace are required by law to cover the same 10 essential health benefits. These include things like emergency care, prescription drugs, and preventive services. The key difference in the metal levels is not in the benefits included, but in the way the costs are shared between the beneficiary and the insurance provider.
You can change your health insurance plan during Open Enrollment, which typically takes place from November 1st to January 15. You may also be able to change during a Special Enrollment Period if you experience a qualifying life event.
Yes, subsidies are available for all metal levels. However, Cost Sharing Reductions, or CSRs, are only available with plans in the Silver category.
There is another type of plan available called a catastrophic plan which does not fall into any of the metal levels. This type of plan typically has a higher deductible and a lower premium than the other tiers. While it must cover the same ten essential health benefits as the other plans, it has a higher deductible and a lower premium than the others. The deductible must be met before it will begin to cover emergency care.
As the name suggests, it’s commonly used for people who expect to use minimal healthcare services and are primarily concerned about accidents and unexpected injuries or illnesses. Only people under 30 or those who have a documented financial hardship are eligible to enroll in this type of plan.
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