Health Plan Categories

Health insurance plans sold through the U.S. Health Insurance Marketplace are grouped into metal tiers—Bronze, Silver, Gold, and Platinum—plus a Catastrophic option. These categories indicate how costs are typically split between the insurer and the enrollee, and they all must cover the same essential health benefits and free preventive services.

How the categories work

• The “metal” level reflects average cost-sharing: plans that pay more of your care have higher monthly premiums and lower out-of-pocket costs when you use services.
• Cost-sharing is delivered through a combination of deductibles, copayments, and coinsurance; plan designs vary in how these elements are arranged.
• You always pay a monthly premium, regardless of use. Plans with lower deductibles and coinsurance typically have higher premiums.
• When comparing plans, evaluate both the monthly premium and the expected out-of-pocket costs for the care you anticipate.

Typical plan characteristics

• Bronze
• Lowest monthly premiums.
• Highest out-of-pocket costs (larger deductibles and higher copay/coinsurance).
• Best for people who want lower monthly cost and can afford higher costs if they need care; protects against catastrophic bills.
• Silver
• Moderate premiums and moderate out-of-pocket costs.
• Only Silver plans are eligible for cost‑sharing reductions (CSRs) if you qualify based on income; CSRs lower deductibles and out-of-pocket costs for eligible enrollees.
• Often a good balance for those who expect some medical use or who qualify for CSRs.
• Gold
• Higher monthly premiums and lower out-of-pocket costs than Bronze or Silver.
• Good for people who expect frequent medical care and prefer predictable, lower costs at the point of service.
• Platinum
• Highest monthly premiums and lowest out-of-pocket costs (lowest deductibles and coinsurance).
• Suited to people with very frequent or expensive healthcare needs who prefer to pay more monthly for lower costs when care is received.
• Catastrophic
• Available to people under 30 and to others who qualify for a hardship exemption.
• Very low premiums but high deductibles; designed to protect against major, unexpected medical costs while keeping monthly cost down.

Who qualifies for Catastrophic plans

• Generally available to:
• People under age 30.
• Any-age enrollees granted a hardship exemption for reasons such as homelessness, major disaster-related property loss, recent bankruptcy, or other specified circumstances.

Common types of cost you may pay

• Premium: monthly payment to keep coverage.
• Deductible: amount you pay before most benefits kick in.
• Copayment (copay): fixed fee for a service (e.g., $30 per visit).
• Coinsurance: percentage of the cost you pay after the deductible (e.g., 20%).
• Non-covered expenses: services not included in the plan’s benefits.

Choosing a plan

• Estimate expected healthcare use for the coming year and compare total expected costs (premiums + expected out-of-pocket).
• If you qualify for cost-sharing reductions, prioritize a Silver plan to receive them.
• If you rarely use care and want low premiums, a Bronze or Catastrophic plan may make sense.
• If you expect frequent care, consider Gold or Platinum for lower point-of-service costs.
• Compare plan details (deductibles, copays, provider networks, drug formularies) rather than relying solely on the metal tier.

Bottom line

Metal tiers help you balance monthly premium cost against out-of-pocket risk. All Marketplace plans cover essential benefits and preventive services, but plan design (deductible, copays, coinsurance, network) determines how and when you pay. Consult a licensed broker, agent, or Marketplace assister if you need help selecting the plan that best fits your budget and health needs.