01Bronze
Lowest premium, highest cost when you use care
Designed to pay about 60 percent of covered costs across a standard population. A fit if you mostly want protection from a large medical bill and rarely see a doctor.
Plan types
Metal tiers, networks, and what actually differs.
Two labels describe every marketplace plan. The metal tier tells you how costs are split. The network type tells you which doctors you can use. You need both to compare fairly.
Metal tiers
Four tiers, one set of covered benefits.
Bronze, Silver, Gold, and Platinum all cover the same 10 essential health benefits. What changes is the split between your monthly premium and what you pay when you get care.
02Silver
The middle tier, and the only one with extra savings
Designed to pay about 70 percent of covered costs. Silver is the only tier where cost-sharing reductions apply, which can lower your deductible and copays if your income qualifies.
03Gold
Higher premium, lower cost at the point of care
Designed to pay about 80 percent of covered costs. Worth comparing if you take regular prescriptions, see specialists, or expect a procedure this year.
04Platinum
Most paid by the plan
Designed to pay about 90 percent of covered costs, with the highest premium and the lowest costs when you use care. Platinum is not offered by every insurer in every county.
Network types
The letters after the plan name set the rules.
- HMO: you use the plan network and usually pick a primary care doctor who refers you to specialists. Care outside the network is generally covered only in an emergency.
- PPO: you can go outside the network at a higher cost, and referrals are usually not required. That flexibility often comes with a higher premium.
- EPO: a network-only plan like an HMO, but usually without the referral requirement. Out-of-network care is generally not covered except in emergencies.
- POS: a hybrid that uses referrals like an HMO but pays something toward out-of-network care like a PPO.
- Catastrophic plans: available to people under 30 and to some people with a hardship or affordability exemption. They cover essential health benefits with a very high deductible, and premium tax credits cannot be used on them.
How to compare
Six things worth checking before the premium.
The cheapest premium and the cheapest year are rarely the same plan. Comparing on these six points takes a few extra minutes and is where almost all of the real difference between plans shows up.
- Monthly premium after any premium tax credit is applied, since the sticker price and your price are usually different numbers.
- Deductible, and whether prescriptions or office visits are covered by copay before you meet it.
- Out-of-pocket maximum, which is the true worst case for in-network covered care in a plan year.
- Provider network: check your doctors and your hospital by name with their offices, not only in the plan directory.
- Drug list: check every prescription you take, its tier, and whether the plan requires prior authorization or step therapy.
- Where you would go for urgent care, and whether telehealth visits are covered and at what cost.
At a glance
How the tiers are designed to split costs.
- of covered costs paid by a Bronze plan on average
- 60%
- Silver, the only tier with cost-sharing reductions
- 70%
- Gold
- 80%
- Platinum, where offered
- 90%
Good to know
Questions people ask about plan types.
Does a higher metal tier mean better doctors?
No. The metal tier describes only how you and the plan split covered costs. Network quality, drug coverage, and customer service are separate questions, and a Bronze and a Gold plan from the same insurer often share the same network.
Do all tiers cover the same things?
Yes, in the sense that every marketplace plan at every tier covers the 10 essential health benefits and cannot exclude a pre-existing condition. What differs is your share of the cost and the specific network and drug list of each plan.
Why would anyone pick Bronze over Silver?
Because the monthly premium is lower and Bronze still protects you from a catastrophic bill through the out-of-pocket maximum. It is a reasonable choice for someone who uses very little care and does not qualify for cost-sharing reductions. If you do qualify for those reductions, a Silver plan is usually the stronger value.
What is an out-of-pocket maximum?
It is the most you pay in a plan year for covered in-network services, counting deductibles, copays, and coinsurance but not your premiums. After you hit it, the plan pays 100 percent of covered in-network care for the rest of the year. Federal limits cap how high it can be, and the cap is updated annually.
Can I keep my current doctor?
Only if that doctor is in the network of the plan you choose. Networks change every plan year, so confirm directly with the office that they will accept the specific plan for the coming year, including the plan name and network name, before you enroll.
Your county
Compare marketplace plans side by side.
Enter your ZIP code to see the tiers, networks, and prices available where you live.