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Types of ACA Health Plans
Health insurance does not cover all your costs entirely; your coverage will vary based on the type of plan you select. Individual and family plans are categorized into five levels, reflecting how much you and your health plan will each contribute to your healthcare expenses.
Four of these levels are named after metals, indicating different coverage levels and costs. You can use these metal levels to compare plans; for example, a silver plan from Company A should provide similar benefits and coverage as a silver plan from Company B.
AFFORDABLE CARE ACT PLAN LEVELS AND COVERAGES
BRONZE
BRONZE
BRONZE
Bronze is the lowest tier in the ACA metal classification, which means bronze health insurance plans have the lowest monthly premiums. However, individuals using these plans will face higher out-of-pocket costs compared to higher metal levels. They typically also have higher deductibles that must be met before the plan starts providing co
Bronze is the lowest tier in the ACA metal classification, which means bronze health insurance plans have the lowest monthly premiums. However, individuals using these plans will face higher out-of-pocket costs compared to higher metal levels. They typically also have higher deductibles that must be met before the plan starts providing coverage. On average, individuals pay 40% of their medical expenses, while the bronze plan covers 60%.
SILVER
BRONZE
BRONZE
Silver plans are one tier above bronze in the health insurance marketplace. These plans offer affordable monthly premiums with slightly lower deductibles and out-of-pocket costs. When care is needed, individuals pay around 30% of the expenses, while the plan covers 70%.
Silver plans are unique in that they allow for cost-sharing reduction
Silver plans are one tier above bronze in the health insurance marketplace. These plans offer affordable monthly premiums with slightly lower deductibles and out-of-pocket costs. When care is needed, individuals pay around 30% of the expenses, while the plan covers 70%.
Silver plans are unique in that they allow for cost-sharing reductions. Those eligible for these subsidies can significantly lower their total costs based on their income and family size, which will automatically reflect in the plan's out-of-pocket maximum.
GOLD
BRONZE
PLATINUM
Gold plans fall within the ACA metal premium tiers and offer high premiums but low out-of-pocket costs for healthcare services. These plans come with low deductibles, allowing individuals to access their coverage more easily. On average, gold plans cover 80% of medical expenses, with individuals responsible for the remaining 20%.
PLATINUM
ESSENTIAL BENEFITS
PLATINUM
Platinum plans are the highest tier in the ACA metal classification. They feature the highest monthly premiums but the lowest out-of-pocket costs and deductibles. Platinum plans cover 90% of medical expenses, leaving individuals to pay just 10%.
Plans with higher premiums (like platinum and gold) cover a larger share of your costs when yo
Platinum plans are the highest tier in the ACA metal classification. They feature the highest monthly premiums but the lowest out-of-pocket costs and deductibles. Platinum plans cover 90% of medical expenses, leaving individuals to pay just 10%.
Plans with higher premiums (like platinum and gold) cover a larger share of your costs when you receive care, including fees, prescriptions, and durable medical equipment.
Conversely, if you choose a plan with a lower premium (like silver or bronze), you'll be responsible for a greater portion of those costs.
CATASTROPHIC
ESSENTIAL BENEFITS
ESSENTIAL BENEFITS
Catastrophic coverage is below the bronze level. These plans feature low premiums but high deductibles. You'll need to cover all costs until you meet your deductible, after which your plan will begin to pay. Catastrophic plans are designed to protect against the costs of major illnesses or injuries and offer limited assistance with routin
Catastrophic coverage is below the bronze level. These plans feature low premiums but high deductibles. You'll need to cover all costs until you meet your deductible, after which your plan will begin to pay. Catastrophic plans are designed to protect against the costs of major illnesses or injuries and offer limited assistance with routine medical expenses. They are primarily intended for individuals under 30, although those over 30 may qualify for a hardship exemption. More information on hardship exemptions can be found at HealthCare.gov or by contacting your state's health insurance marketplace.
ESSENTIAL BENEFITS
ESSENTIAL BENEFITS
ESSENTIAL BENEFITS
All individual and family health plans are required to cover a comprehensive list of services known as "essential health benefits," including:
- Same-day services (office visits, outpatient care)
- Emergency services
- Prescription drugs
- Laboratory services
- Hospitalization (including surgeries and overnight stays)
- Pregnancy, maternity, and newborn ca
All individual and family health plans are required to cover a comprehensive list of services known as "essential health benefits," including:
- Same-day services (office visits, outpatient care)
- Emergency services
- Prescription drugs
- Laboratory services
- Hospitalization (including surgeries and overnight stays)
- Pregnancy, maternity, and newborn care (before and after birth)
- Pediatric services (medical and dental care for children)
- Rehabilitative and habilitative services and devices (for recovery of skills after injury or chronic conditions)
- Mental health and substance use services
- Preventive care and chronic disease management