When you buy individual and family health insurance, you get to choose from hundreds of different plans. With so many options to choose from, narrowing in on the right one can be difficult. Complex cost-sharing rules make side-by-side comparisons time-consuming.
To help you narrow down your plan options, the Marketplace categorizes health insurance plans by metal tiers. Each metallic level represents an actuarial value, a summary measure of the coverage provided by a health insurance plan. It estimates the percentage of medical expenses a plan would cover for the average person.
Bronze plans have an actuarial value of roughly 60 percent.
Silver plans have an actuarial value of roughly 70 percent.
Gold plans have an actuarial value of roughly 80 percent.
Platinum plans have an actuarial value of roughly 90 percent.
In general, health insurance premiums increase with the metal tier value. However, exceptions are possible.
The metal tier is a useful starting point for selecting a plan, but it does not help you decide which one is best for you. Here are a few reasons why.
- Copayments, coinsurances, and deductibles often vary within the same metal tiers.
- Only services that are essential health benefits count in the calculation. The metal tier ignores any additional services the plan covers.
- The metal tier doesn’t reflect the insurance company’s customer service or provider network.
- The metal tier doesn’t tell you whether the plan is compatible with a health savings account (HSA).
Use metal tiers to understand your high-level health insurance options. Then, dive into each plan’s details to pick the right one for you and your family.