There are a number of factors to consider when you sign up for a healthcare plan through the Marketplace. Between understanding the difference between HMO and PPO plans and checking if your doctor participates in the plans you’re considering, adding another factor to consider may feel overwhelming. However, the four metal tiers – Bronze, Silver, Gold, and Platinum – are simple ways to guide your decision-making and better understand health plan structures and costs.
These metal tiers are a way to describe how the plan will share costs with you. The easiest way to think about it is the more expensive the metal, the more the monthly payments are but the sooner the plan will start to share costs. For example, a Bronze plan will have lower monthly premiums than a Silver plan, but the deductible, the amount someone pays out-of-pocket before their insurance kicks in, is higher. On the other hand, Platinum plans have the highest monthly premiums, but the plan starts to pay sooner because the deductible is lower. Bronze plans are often a good choice for someone whose healthcare utilization is low and who can bear the financial risk of higher deductibles when they do need healthcare, whereas Gold and Platinum plans may be more cost-effective for someone who has high healthcare usage and wants a lower deductible.
Below is an estimate of each metal tier’s coverage and premium level:
It’s also important to consider your financial situation and your risk profile, meaning what resources you have to cover the out-of-pocket maximum (the point where the plan starts paying for 100% of in-network costs) for a plan if you utilize the healthcare system often, as well as factors like your participation in recreational sports or planned surgeries in the next year. Let’s say you get injured during a tennis match and your urgent care visit costs $2,000. With a bronze plan that has a deductible of $4,000, you will need to pay the entire $2,000 urgent care bill. With a platinum plan that has a deductible of $750, you’ll only pay $750 and the plan would pay the rest of the $1,250.
The metal tiers can help guide you to the right plan for you financially, and don’t forget that a HealthPlanning Analysis can help you identify which plan types are best for your needs and goals.
Learn More:
Choosing Bronze, Silver, Gold, or Platinum Health Plans | Investopedia
Last Revised July 13th, 2023
