Five Categories of Health Care Plans
The Affordable Care Act (ACA) has prompted health insurance companies to offer health care plans in five categories. The category you choose determines how you and your plan share the costs of care. This structure helps make it easy to compare health care plans from a range of companies.
The plans are divided into four “metal levels”, plus catastrophic. Catastrophic coverage is available to people who are under 30 years of age or those who have a hardship exemption as defined by the ACA.
Health Plan Metal Levels
Health plans in each category pay different amounts of the total costs of an average person’s care. The actual percentage you’ll pay in total or per service will depend on the services you use during the year. The plans in each category offer the same essential benefits, and can include added coverage depending on the specific plan.
Your health care plan pays 60% on average. You pay about 40%. These plans generally feature the lowest premiums and higher out-of-pocket costs (cost you pay that don’t include the premium). This may be a good choice if you don’t go to the doctor often or take prescriptions.
- Silver: Your plan pays 70% on average. You pay about 30%. Premiums are generally higher with these health care plans than for Bronze plans.
- Gold: Your health plan pays 80% on average. You pay about 20%. Premiums are higher with the Gold plans, but out-of-pocket costs will likely be lower. This may be a good choice if you go to the doctor often or take prescriptions regularly.
- Platinum: Your plan pays 90% on average. You pay about 10%. These plans generally have the highest premiums and offer the lowest out-of-pocket costs. These plans are often selected by those who want comprehensive coverage.
- Catastrophic: Catastrophic coverage plans pay less than 60% of the total average cost of care on average. They’re available to people who are under 30 years old or have a hardship exemption.
The category you choose helps determine how you and your health care plan share the costs of care. These categories have nothing to do with the quality or amount of care you get.
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