Plan category levels
Marketplace plans are available in four metal levels: Bronze, silver, gold and platinum (an expensive and less popular option). Below we explain the best options for most people.
Bronze
Average premium:* $526 per month
Average premium w/subsidy:* $125 per month
Coinsurance: Insurance company pays 60%, you pay 40%
Monthly premiums: Low
Out-of-pocket routine care costs: Highest
Deductibles (amount you pay before coverage starts): Highest
Best for: Those who don’t need a lot of medical services and want low-cost coverage for emergency medical needs.
Jacob
Meet Jacob. He lives alone and has a higher-paying, part-time job that doesn’t offer health insurance. Jacob is young and has no major health issues. Because his savings will cover any emergency medical expenses, he chose a Bronze plan to get the most cost-efficient coverage.
Silver
Average premium:* $623 per month
Average premium w/subsidy:* $77 per month
Coinsurance: Insurance company pays 70%, you pay 30%
Monthly premiums: Moderate
Out-of-pocket routine care costs: Moderate
Deductibles (amount you pay before coverage starts): Lower than bronze plans
Best for:Those who qualify for cost-sharing reductions to lower out-of-pocket expenses. Silver is the most popular plan.
Lauren
Meet Lauren. She and her husband, Daniel, have two young children, and both have jobs that don’t provide health insurance. Their income is low, so they qualify for premium subsidies that will reduce their out-of-pocket expenses. Even though they don’t have any serious medical conditions or expect any near-term issues, the extra subsidies available with Silver plans made this the best option for them.
Gold
Average premium:* $677 per month
Average premium w/subsidy:* $276 per month
Coinsurance: Insurance company pays 80%, you pay 20%
Monthly premiums: High
Out-of-pocket routine care costs: Low
Deductibles (amount you pay before coverage starts): Low
Best for: Those who don't mind paying a higher monthly premium in exchange for lower out-of-pocket expenses.
Gold plans make sense for people who regularly use healthcare services.
Chris
Meet Chris. He and his wife, Emily, don’t have children, but Chris has a chronic condition that requires ongoing care. Both Emily and Chris are high-income, independent contractors who want robust health coverage with low out-of-pocket costs. For this reason, they’ve selected a Gold plan.
*Average premiums based on 2022 open enrollment data from Healthcare.gov.
Premium amounts will vary based on plan selection, location, year and family size.
Deductibles are fixed dollar amounts you must pay out of pocket before coverage kicks in. Deductibles vary for each metal level, decreasing as premiums increase.
After you pay your premium and meet your deductible, you are still responsible for a percentage of medical expenses, called a “copay” or “coinsurance” amount.
Actual out-of-pocket costs and billed amounts may vary significantly from the estimate provided in the table above, depending on:
- Your actual healthcare usage
- Type(s) and location(s) of the care you receive
- The accuracy of the information you provide
No matter which metal level you choose, the same set of essential health benefits will be covered:
- Addiction treatment
- Ambulatory patient services
- Birth control and breastfeeding
- Care for newborns and children
- Emergency services
- Hospitalization
- Laboratory services
- Maternity care
- Mental health services
- Occupational and physical therapy
- Prescription drugs
Subsidies
A subsidy is financial assistance provided by the government. You may qualify for subsidy savings on premiums or out-of-pocket expenses (deductible and copay/coinsurance) based on your income. While many people may qualify for subsidies, which have been recently expanded, you can still enroll in a Marketplace plan and pay the full cost if you don’t qualify.
Premium subsidy
Premium subsidies are a form of tax credit that you receive upfront rather than when you file your tax return. This subsidy reduces your monthly premium. This type of subsidy is available no matter which metal level you select.
Cost sharing subsidy
Cost sharing subsidies are an additional form of assistance that will help you to pay your deductible, copays, and / or coinsurance (out-of-pocket costs). If you are eligible for this type of subsidy, you must select a silver plan to receive it.
Find out if you qualify for subsidies, which may lower your deductible.
Check nowOpens a simulated dialogReady to enroll?
Although enrollment usually occurs only once a year during the Open Enrollment Period, you may be eligible to enroll through a Special Enrollment Period if you have experienced a qualifying event, such as a birth, death, marriage, divorce or loss of coverage. For 2025 coverage, federal and state marketplaces have different enrollment deadlines, but the Open Enrollment Period is scheduled to begin November 1, 2024.
Enroll nowOpens a simulated dialog*Average lowest-cost premium before tax credit for a 40 year old.Sources
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