Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.
- The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
Which metal category is right for you?
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — 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.
- Moderate monthly premium
- Moderate costs when you need care
- Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.
- High monthly premium
- Low costs when you need care
- Deductibles — the amount of medical costs you pay yourself before your plan pays — 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.
- 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.
- Your total costs for health care: You pay a monthly bill to your insurance company (a “premium”), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.
When choosing a plan, it’s a good idea to think about your total health care costs, not just the bill (the “premium”) you pay to your insurance company every month.
Other amounts, sometimes called “out-of-pocket” costs, have a big impact on your total spending on health care – sometimes more than the premium itself.
Beyond your monthly premium: Deductible and out-of-pocket costs
- Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)
- Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible
- Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
So how do you find a category that works for you?
- If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.
- If you qualify for extra savings on out-of-pocket costs OR want more of your costs covered: Silver plans probably offer the best value. If you qualify for extra savings (“cost-sharing reductions”) your deductible will be lower and you’ll pay less each time you get care. But you get these extra savings ONLY if you enroll in Silver plan. This can save you hundreds or even thousands of dollars a year if you use a lot of care. Even if you don’t qualify for extra savings, Silver plans offer good value — moderate premiums and deductibles, and better coverage of your out-of-pocket costs than a Bronze or Catastrophic plan provide.
If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.
- Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.
Types of Marketplace plans
Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, and Platinum.
Some examples of plan types you’ll find in the Marketplace:
- Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
- Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
- Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
- Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.