What do the Metallic Health Plan Categories Mean?

To help make it easier for people to compare health insurance, the Affordable Care Act categorizes all health plans using types of metals: Bronze, Silver, Gold, and Platinum.

Each metal type tells you the share of covered medical expenses a health plan will pay versus what share of expenses you can expect to pay. Your share of expenses is often called your “out-of-pocket costs.”

No matter where you look for health insurance, whether on the Marketplace or directly through a health insurer, these metallic categories mean the same thing.

On average, plan pays 60%; you pay 40%
On average, plan pays 70%; you pay 30%
On average, plan pays 80%; you pay 20%
On average, plan pays 90%; you pay 10%

In general, the more the plan pays, the higher your monthly premium will be. So if you think you’ll use a lot of medical care, it would make sense to pay a higher premium for a gold or platinum plan, so you will pay less in out-of-pocket costs each time you need to use your benefits.

The opposite is also true: If you’re healthy, and really only need coverage for check-ups and emergencies, it may make sense to choose a silver or bronze plan with a lower monthly premium because you will pay the higher out-of-pocket costs less often.

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