Chris Kissell has been a journalist for three decades and has written extensively about insurance and other personal finance topics for the past 20 years. For the last 14 years, he has been a full-time freelance writer and editor, contributing to sit.
Chris Kissell Insurance WriterChris Kissell has been a journalist for three decades and has written extensively about insurance and other personal finance topics for the past 20 years. For the last 14 years, he has been a full-time freelance writer and editor, contributing to sit.
Written By Chris Kissell Insurance WriterChris Kissell has been a journalist for three decades and has written extensively about insurance and other personal finance topics for the past 20 years. For the last 14 years, he has been a full-time freelance writer and editor, contributing to sit.
Chris Kissell Insurance WriterChris Kissell has been a journalist for three decades and has written extensively about insurance and other personal finance topics for the past 20 years. For the last 14 years, he has been a full-time freelance writer and editor, contributing to sit.
Insurance Writer Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
| Deputy Editor, Insurance
Updated: Feb 27, 2024, 5:46am
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The federal Affordable Care Act (ACA) makes it easy to purchase a health plan through the health insurance marketplace. Depending on your state, you either buy a plan via the federal health insurance marketplace or a state-run marketplace.
When you shop for health insurance, the ACA marketplace (at Healthcare.gov) presents you with plans in four different categories that differ by costs:
Understanding what these “metal tiers” represent is essential to getting the best health insurance at the right price level for you.
When you shop on the health insurance marketplace, you have the option of selecting a plan from a health insurance company that belongs to one of four categories: Platinum, Gold, Silver or Bronze.
This isn’t the Olympics, where a “gold” metal is better than a “silver” metal. The metal categories don’t indicate the quality of a health plan. The metal tiers are instead used to differentiate health plans based on health insurance premiums and out-of-pocket costs.
On the surface, you may think the Platinum plan would be the best choice for everyone. But that isn’t necessarily so. A Platinum plan has the highest monthly premiums, while the Bronze plan has the lowest monthly health insurance premiums, so the best option for you depends on how much health care you expect to need in the coming year.
Bronze plans have the lowest monthly premiums, which means you can save a lot of money on your monthly health insurance bill, particularly if you rarely see the doctor for anything besides an annual physical.
If you do need health care, though, you will pay more out of pocket for health care services with a Bronze plan than with any other type of metal plan. Health insurance deductibles tend to be high, meaning you could be responsible for paying thousands of dollars in medical bills before the health plan begins to pay out.
Health insurance companies sometimes also offer Expanded Bronze plans. These plans are similar to Bronze plans, but pay slightly more for health care services than a standard Bronze plan but not as much as a Silver plan.
Bronze plans tend to appeal to people who want the lowest premiums or may want comprehensive coverage to protect them from large medical costs but are willing to pay more out of pocket for care.
Your premiums are higher with a Silver plan than a Bronze plan, but they’re still lower than the other two plan types.
Out-of-pocket expenses also will be somewhat in the middle of all of the four plans.
Silver plans make sense for those who are willing to pay a higher premium than Bronze coverage in exchange for lower out-of-pocket expenses when they visit the doctor.
Silver plans are also the go-to choice for anyone who qualifies for cost-sharing reductions based on their income. To get these discounts, you must purchase a Silver plan. The ACA marketplace website factors in those cost-sharing subsidies when you enter your income information when comparing plans, so you will know if you’re eligible when you apply for the plan.
Gold health plans have higher premium costs than either Bronze or Silver plans but lower out-of-pocket costs. Deductibles are considerably lower.
If you use health care services frequently, it’s more likely that a Gold plan will save you money compared to the Silver or Bronze plan. On the other hand, if you rarely go to the doctor, this plan is likely to be more expensive.
Platinum plans, which comprise a tiny fraction of ACA plans, can be a great choice for those who need regular medical care. The premiums are the highest of all the plans, but out-of-pocket costs are significantly lower. Deductibles are low compared to other plans.
Following is the breakdown of how much you will pay for care for each metal level, according to the federal government’s Healthcare.gov website:
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Each metal tier on the health insurance marketplace has its own pros and cons. The right choice for you depends on your anticipated health care needs for the year and budget.
When choosing a metal tier, your primary decision is how much you want to pay for monthly premiums and how much of your care you are willing to pay for out of pocket. As a general rule, the lower your expenses in one of these areas, the higher it will be in the other.
Also, if you want to be eligible for cost-sharing reductions, you must choose a Silver plan.
Beyond the metal tier, you also need to figure out what kind of health insurance benefit design you want, such as an HMO vs. a PPO. The one you choose influences whether you can get out-of-network care covered and whether you need referrals to see specialists.
The four most common types of health insurance benefit designs are:
Selecting the right health plan is a weighty matter. Before shopping for a plan, ask yourself some important questions, such as:
Once you answer these questions, you can narrow your health insurance plan choices.
You can slash your health premium costs significantly if your income qualifies for a premium tax credit. This is true regardless of the metal tier.
The size of the tax credit for which you qualify will depend on your estimated household income. You will need the income information when you apply for coverage to find out whether you’re eligible for a tax credit and how much you can expect to get back as part of the credit.
The federal government’s Healthcare.gov website also has a tool that can help you find out whether you’re likely eligible for the credit.
If you qualify for a credit, You will pay lower premiums and the health insurance marketplace will pay the tax credit amount to your health insurer. This means you will pay a lower monthly premium right away and won’t have to wait to get your credit when you file your tax return.
Because this credit changes the amount you pay monthly for your premium, you must inform your health insurance marketplace right away if your income changes—either up or down—during the year.
Depending on your income, you also might qualify to save on your health insurance costs through what is known as a cost-sharing reduction. This can lower the amount you pay for deductibles, copayments and coinsurance.
However, to get these discounts, you must purchase a Silver plan. When you apply for health insurance coverage, you will find out if you qualify for these reductions. Or you can use the same tool the government provides to estimate your eligibility for the tax credit to find out if you are eligible for a cost-sharing reduction.
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