Ready to buy health insurance? The Marketplace, or Exchange, is a great place to start. The Marketplace is an online health insurance shopping center based at HealthCare.gov.
At the Marketplace, there are four levels of plans: bronze, silver, gold, and platinum. (“Catastrophic” plans may be available to some people.) Each level pays a different portion of your health care bills. Grouping plans this way makes it easier to shop for insurance. For example, the top-of-the-line plan is Platinum. It pays the highest portion of your health care bills (90%). It also costs the most. The most basic plan is Bronze. It pays 60% of your health care bills and costs the least.
Check out the chart below to see how you and your plan share costs at each level. Also, note that the levels are named after metals. So, sometimes you’ll hear the terms “metal plans” or “metal levels.”
Marketplace plans at a glance
|Plan Category||Plan Pays||You Pay||Price Tag|
Here are five things to keep in mind when you shop at the Marketplace:
All Marketplace health plans cover the 10 Essential Health Benefits defined by the ACA law
The way you and your health insurance carrier split the costs of health care varies by plan level. But all Marketplace plans give you the same essential health benefits. For example, annual check-ups, routine mammograms, and diabetes screenings are 100% covered when you go in-network,* no matter which plan you choose. Every plan gives you access to other vital care, too. If you have to stay overnight in the hospital, go to an emergency room or clinic, get care for your kids, or get therapy and other treatments to get better, you'll be covered.
Higher-priced plans pay a higher portion of your eligible medical bills
You'll pay the highest monthly premium for a plan where the carrier pays the highest portion of your health care bills. Let’s say you pay a higher monthly premium for your plan. In return, your plan pays a higher share of your eligible health care costs.
You can count on copays
Most plans have copays . The actual copay amount will vary based on the plan and the service.
Plans in the same metal level could have different deductibles and coinsurance
Deductibles and coinsurance can vary among plans in the same metal level. For example, two Gold plans will have the same annual out-of-pocket maximum, but different deductible and coinsurance amounts. So it’s best to read your plan documents closely. This way, you’ll know what you need to pay when you get care.
You may be able to get help paying for your plan
Depending on your household size and income, you may be able to get federal financial assistance toward your qualified Marketplace health plan from the Federal Government. Find out about federal financial assistance.
Tips for choosing your plan.
So how do you decide which plan is right for you? Start by thinking about your past and future medical bills. For example, let’s say you’re healthy most of the time and don’t expect to need costly medical services during the year. A Bronze plan, which has a lower monthly premium and pays for a lower portion of your eligible medical bills, may be a good choice for you.
On the other hand, let’s say you have a medical condition and you know you'll need care. Or you have an active family with children who play sports. A Gold or Platinum plan that pays for more of your medical costs may be better for you.
*Plans may vary. Includes eligible in-network preventive care services. Some preventive care services may not be covered, including most immunizations for travel. Reference plan documents for a list of covered and non-covered preventive care services.