What Do the Health Insurance Metal Levels Mean?

Most plans available through the Affordable Care Act (ACA) Health Insurance Marketplace are categorized into one of four metal levels: bronze, silver, gold or platinum. The purpose of these categories is to differentiate between plans that come with higher premiums and plans that come with higher out-of-pocket costs.

Keep reading for a more in-depth breakdown of the health insurance tier system including what percentage of the costs you can generally expect to pay with each type of plan.

Key Takeaways Most Marketplace health plans are labeled as bronze, silver, gold or platinum to indicate how they split expenses between you and your insurer. Lower-tiered categories like bronze and silver have lower premiums and higher out-of-pocket costs, while higher-tiered plans like gold and platinum have higher premiums and lower out-of-pocket costs. Silver is the most popular health plan metal level and you must pick a silver plan to take advantage of income-based cost-sharing reductions. You can switch to a plan in a different tier during open enrollment and some types of special enrollment periods.

What Health Plan Categories Are There?

The health insurance tier system groups plans into four tiers, also known as categories or metal levels: bronze, silver, gold and platinum. This tier system helps indicate how the costs are split between you and your insurance company for any given health plan.

There are two main types of costs associated with health insurance. Your premiums are the payments you make, usually on a monthly basis, to maintain coverage regardless of whether you receive any medical services. Meanwhile, the out-of-pocket costs explained below may also apply each time you receive a medical service.

• Deductibles: Your deductible is a predetermined amount of money you have to spend out of pocket on covered services each year before your insurance company will start contributing any money. Note that this doesn’t apply to certain preventive services like shots and screenings from in-network providers since Marketplace health plans cover these for free regardless of whether you’ve hit your deductible.^[1]
• Copays: A copayment is a flat rate you have to pay out of pocket every time you receive a covered medical service after meeting your deductible. For example, if your plan requires a $20 copay for routine doctor’s appointments, you must pay $20 every time you visit a doctor and your insurance carrier will pay the rest of the bill as long as you’ve met your deductible.
• Coinsurance: Coinsurance payments are similar to copays except the amount you have to pay out of pocket is set at a percentage of your medical bill rather than a flat rate. For example, if your plan requires a 30% coinsurance payment for emergency room visits and you get a $1,200 bill after going to the ER, you would pay $360 and your insurer would cover the remaining $840 as long as you’ve met your deductible.
• Out-of-pocket maximum: The out-of-pocket maximum is the highest amount of money your plan can require you to pay in deductibles, copays and coinsurance per year. Once you have reached your out-of-pocket maximum, your insurance provider will foot the entire bill for any medical expenses you incur before your out-of-pocket costs reset, which should occur at the beginning of a new year or whenever your policy renews depending on the details of your plan.

The health insurance tiers don’t suggest what plans offer higher quality care than others but instead whether a plan comes with higher premiums or higher out-of-pocket costs. In general, the health insurance metal levels divvy up expenses in the following ways:

• Bronze: Bronze plans have the lowest premiums and the highest out-of-pocket costs.
• Silver: Silver plans have low premiums and high out-of-pocket costs.
• Gold: Gold plans have high premiums and low out-of-pocket costs.
• Platinum: Platinum plans have the highest premiums and the lowest out-of-pocket costs.

How Do Copays Work for Each Category?

The below table goes over the percentage of medical expenses you will typically be responsible for in each health insurance category when taking all of your out-of-pocket costs into account. Keep in mind that these percentages are estimated averages and not every plan in a certain tier will necessarily cover that exact percentage of your medical expenses.^[2]

Category	How Much the Insurance Company Pays	How Much You Pay
Bronze	60%	40%
Silver	70%	30%
Gold	80%	20%
Platinum	90%	10%

How Do I Choose the Right Health Plan Category?

To determine which type of health insurance plan best suits your needs, you will generally need to consider how often you expect to need medical services, how much money you have saved up in case of an emergency and whether you would rather pay more money over time or all at once.

Bronze

A bronze plan may be best for you if you are generally healthy and have a sizable amount of money saved up to cover your plan’s high deductible in case of a serious medical emergency. Keep in mind that the deductible for a bronze health insurance plan is often thousands of dollars per year.^[2]

If you need healthcare services frequently, a bronze plan will likely cost you more in the long run since you will have more out-of-pocket costs every time you receive a medical service. However, if you rarely need healthcare services, a bronze plan can offer you low monthly premiums while still providing coverage to help protect against worst-case scenarios.

Silver

Silver plans strike the best balance between premiums and out-of-pocket costs for many Americans, making silver the most popular health insurance tier. In fact, more than half of the customers who purchased or were reenrolled into an ACA Marketplace health plan for 2023 opted for a silver plan.^[3]

In addition, depending on your income, you may qualify for cost-sharing reductions that lower the out-of-pocket costs associated with your health insurance plan. However, you cannot actually claim those reductions unless you select a silver plan.^[2]

Gold

If you or your family members need medical services fairly regularly and you can afford to budget for higher-than-normal premiums, a gold health insurance plan may be a good fit for you. Gold plans have low deductibles and in some cases won’t have a deductible at all, although they will still have higher out-of-pocket costs and maximums than platinum plans.

Platinum

You will likely only benefit from a platinum health insurance plan if you have a chronic health condition that requires frequent hospital visits or other kinds of medical treatments. Less than 1% of the customers who enrolled in a Marketplace plan for 2023 settled on a platinum plan, making it fairly unlikely that the average American would benefit from a plan in this category.^[3]

Nevertheless, a platinum plan can make healthcare more accessible if you frequently require expensive medical services and can only afford to pay for a small percentage of those services out of pocket. While your premiums will be quite high, it may be easier to set aside more money for your regular premium payments than to account for the high prices that can come with sometimes unpredictable medical treatments.

Can I Switch Health Plan Categories?

You can freely switch to a health plan in a different tier during open enrollment, which runs from November 1 to January 15 in most states.^[4] It’s also possible to change health plan categories during special enrollment periods triggered by certain qualifying life events like gaining access to an employer-sponsored health plan or losing access to cost-sharing reductions. However, not all special enrollment periods allow you to switch to a different metal level.^[5]

For example, if you qualify for a special enrollment period by moving to a new home or losing your existing health insurance, you must pick a plan in the same category as your previous plan. Meanwhile, you can switch to a plan that is one metal level up or down from your current plan if you get married or have a child but only if you can’t add the new family member to your existing plan and there are no available plans in your current metal level.^[5]

Keep in mind that becoming sick or injured doesn’t trigger a special enrollment period.

As a result, you shouldn’t plan on buying a bronze plan so you can pay low premiums throughout the year and then switching to a platinum plan as soon as you actually need to access medical services since this likely won’t be an option for you.

How To Enroll in a Health Plan Category

You can shop for health insurance and enroll in plans through either the federal Health Insurance Marketplace at HealthCare.gov or your state’s equivalent marketplace website if applicable. Every plan will have its category listed so you can search for plans based on your preferred category to make it easier to compare health insurance rates before signing up for a plan that suits your needs and budget.