Platinum, gold, silver, and bronze plan categories explained

If you choose to get your health insurance through the government’s Marketplace, you’ll see a few different plan options with metal names. These are health insurance plan categories.

What do platinum, gold, silver, and bronze plans actually mean?

Platinum, gold, silver, and bronze plans are categories of health plans.¹ They represent how much different plans will cover and how much you will pay for coverage.

What does a bronze plan cover?

Bronze health insurance plans generally come with the highest deductible, but lower monthly premiums. The plan usually pays 60% of covered services and you pay 40%. Your actual costs will vary by plan.

Bronze plans and catastrophic plans are eligible for a health savings account (HSA). These are savings accounts dedicated to healthcare costs. You can set aside pre-tax dollars to save for medical care costs. HSA funds can be used to cover copays, coinsurance, some medical devices, and more.

What does a silver plan cover?

Silver health insurance plans often have a moderate deductible and higher premiums than a bronze plan. Usually the insurer will pay 70% of covered service costs and you’ll pay 30%.

Sometimes, you’ll see a “Silver with extra savings” category. If you apply and qualify for health insurance savings, this plan may be an option for you.² These plans usually have a low deductible. The insurer will generally cover 73-96% of service costs and you pay the remaining 6-27%, depending on how much in savings you qualify for.

What does a gold plan cover?

Gold health insurance plans usually have lower deductibles but higher monthly premiums. The plan is generally responsible for 80% of covered service costs and you are responsible for the remaining 20%.

What does a platinum plan cover?

Platinum health plans usually have the lowest deductibles and the highest premiums. The insurer will typically cover 90% of covered service costs and you pay the remaining 10%.

What all Marketplace plans are required to cover

No matter what plan you choose, each Marketplace plan must cover certain essential health benefits (EHB), according Healthcare.gov.³ While they may not cover all costs associated with the service, they provide some coverage.

These 10 essential health benefits are covered on every plan:

• Ambulatory patient services – May include office visits, diagnostic tests, minor procedures, seeing a specialist, urgent care
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care (before and after birth)
• Counseling and psychotherapy for behavioral health disorders
• Prescription medications
• Lab services
• Preventive services and chronic disease management
• Pediatric services, including oral and vision care

If you’re looking for a health plan, visit our plans page to see Marketplace plans Select Health offers and what services are covered.

How to choose the right health insurance plan from the Marketplace

When you’re choosing a plan from the federal or your state’s Marketplace, you need to gather some information about your budget and needs before choosing a plan.

Your budget for a premium and out-of-pocket costs

It’s important to determine how much money you can spend on a premium each month. That will be the set cost you pay to have coverage throughout the year. Additionally, you may have to pay other out-of-pocket costs, like copays, coinsurance, and deductibles.

When you’re looking at the plan’s summary of benefits, you can start to see how much each type of service will cost you and whether you share costs with your plan through coinsurance.

How often you need care

Looking back at the last year or two, how often did you need to see a doctor or get a prescription? Determining how regularly you need care can help you figure out the right plan. Different plan categories often have different services they cover.

Say, for example, you see a cardiologist four times per year, a dermatologist once per year, and your primary care provider (PCP) twice per year. You also take three medications every day. Before you choose a plan, you should calculate how much those services will cost with the plan’s copays, coinsurance, and whether you need to reach a deductible before your insurance starts to cover costs. A gold or silver plan may be a good fit for these types of medical needs.

If you’re someone who sees a doctor once a year for a checkup and is generally healthy, a bronze plan or a plan with a higher deductible and lower monthly premium may be a good fit.

The plan’s provider network

Looking at the plan’s provider network is an important step many people might gloss over. But checking out the providers and hospitals that are in-network can save you time and money when you need to get care.

If you already have a doctor you like, make sure they accept the plan you’re considering. Some providers don’t accept certain types of plans from an insurer. Imagine a doctor is in-network for plans A and B. When you call, they tell you they only accept patients using plan A. Knowing this ahead of time can save you time and money.

Additionally, make sure the hospitals and medical centers near you are in-network so you’ll have access to care close to home.

Prescription medication coverage

If you take any prescription medications, check the plan’s formulary—the list of medications they cover. Take note of your prescriptions to see if they’re included and how much each refill will cost.

Talk to an expert for personalized help

If you’re shopping for a new health insurance plan, getting personalized help with Select Health is simple. You can contact your agent, visit our website to browse plans or call Individual Sales at 855-442-0220 (toll-free) to find the right plan for you.