Key takeaways:
There are four metal categories for health plans offered through the Affordable Care Act: bronze, silver, gold, and platinum.
Every plan will have a monthly premium that you pay out of pocket and that may be reduced by a premium subsidy. Bronze plans have the lowest monthly premiums, while platinum plans have the highest.
When you need care other than covered preventive health services, there will be out-of-pocket costs before your insurance begins to pay. Bronze plans have the highest costs when you get care, and platinum plans have the lowest.
ACA health insurance plans are organized into four metal categories: bronze, silver, gold, and platinum. Each metal tier represents how you will split the costs of care with your plan. With bronze plans, you pay the least in premiums and the most when you need care. Platinum plans have the highest premiums, but the lowest costs when you need health services.
What should I know before I pick an ACA insurance plan?
Figuring out which health insurance plan to choose can be difficult. You will need to estimate your household budget for the coverage year.
Consider how much healthcare you expect to use and whether anyone who will be covered takes prescriptions regularly. If you don’t expect to access much care, you might want to choose a bronze plan. If you want to qualify for help with your out-of-pocket costs, you must choose a silver plan. If you believe you will need lots of doctor visits and medications, you might want to select a gold or platinum plan.
There are three main areas to learn about before making your choice:
Four metal categories: Understanding the cost-sharing differences between these plans can help you make the right decision for yourself and your family. Metal categories reflect costs by ranking your out-of-pocket expenses. Metal tiers do not relate to the quality of care.
Total costs for healthcare: An insurance plan involves a monthly cost with out-of-pocket expenses when you need care. The premium is your monthly payment to the insurance company whether or not you use health services. When you receive care, there may be out-of-pocket expenses or cost-sharing. Those costs include a deductible, copayments, and coinsurance.
Plan types and networks: Do your research and make comparisons. Plans offer different benefits. Some plans allow you to see almost any doctor you choose, anywhere you want. Others require you to choose providers and facilities from those that are in-network — or you will be charged more. Choose plans that offer the benefits that you need. If you have certain providers you want to see, make sure they are in-network for the plan you choose. While metal categories do not reflect the quality of care, plans may have different quality ratings.
What are the four “metal” categories?
Affordable Care Act health plans fall into “metal tiers,” which determine how you and your plan will split the cost of care. The metal tier categories are:
Bronze: Lowest monthly premium but highest costs when you need care.
Silver: This is known as the “benchmark” plan because of its moderate monthly premiums and moderate costs when you need care. You must choose a silver plan to qualify for cost-sharing reductions. These are also known as “extra savings” on out-of-pocket expenses such as deductibles, copayments, and coinsurance.
Gold: High monthly premium but low costs when you need care.
Platinum: Highest monthly premium and the lowest costs when you need care.
Healthcare.gov offers these estimated cost-sharing averages for a typical population:
| Plan category | The insurance company pays | You pay |
|---|---|---|
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
If you have a silver plan with extra savings, your plan pays 73% to 96% of your costs — depending on how much you are qualified to receive.
What are the costs of each health plan?
Any plan you choose will have a monthly premium. Because of affordability provisions of the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, 4 out of 5 people will be able to find a plan for $10 or less per month.
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If you qualify, a premium tax credit — also known as a premium subsidy — will reduce your monthly bill.
A KFF national analysis of marketplace plans for a 40-year-old person found that the average premium (without subsidies) for the silver plan in 2025 is $497. The price ranges from $325 in New Hampshire to $1,277 in Vermont.
The total costs of each plan will depend on what kind of plan you choose and how much you access care. Your monthly premium for the coverage year remains the same unless you have a change known as a qualifying life event. Beyond your monthly premium, there are out-of-pocket costs:
Deductible: This is how much you will spend before the insurance begins to pay, except for preventive health services. Routine care such as checkups and screenings in your plan’s network are provided without you paying a deductible or other out-of-pocket expenses.
Copayments and coinsurance: These are payments you may make each time you get a service, excluding preventive health services. A copayment or copay is a fixed amount that you pay after meeting your deductible. Coinsurance is a percentage of the cost of a covered health service after you have met your deductible.
Out-of-pocket maximum: Also known as the out-of-pocket limit, this is the most you must pay for covered services in a plan year. After your deductible, copayments, and coinsurance reach this amount, all covered services in a plan year are paid 100% by the insurance company. For 2025 marketplace plans, the out-of-pocket maximum is $9,200 for an individual and $18,400 for a family.
What are catastrophic health plans?
Catastrophic health plans are for people who want to protect themselves from huge financial bills in the case of serious illness. Catastrophic plan premiums are very low. But, deductibles — which you pay out of pocket first before your benefits begin — are extremely high. In 2025, ACA catastrophic health plans will have an annual deductible of $9,200 for individual. But these plans cover preventive health services without meeting a deductible.
Catastrophic plans are available only for people under 30, or people of any age with a hardship exemption. A hardship can include an affordability exemption for marketplace premiums or job-based insurance that are too expensive for you.
Hardships can include many circumstances, such as:
You were homeless.
You were evicted, faced eviction, or faced foreclosure.
You experienced domestic violence.
You experienced a natural or human-made disaster — such as fire and flood — that caused major damage to your property.
You received a shut-off notice from a utility company.
You experienced the death of a family member.
You filed for bankruptcy.
The bottom line
The four metal categories offer a simple way to help you select a health plan that is right for you and your family. Whether you choose a bronze, silver, gold, or platinum option will determine your combination of premiums with out-of-pocket costs — but not quality of care. The plan you choose is likely to depend on your estimated budget and your expected healthcare needs for the plan year.
Why trust our experts?
References
Healthcare.gov. (n.d.). 3 things to know before you pick a health insurance plan.
Healthcare.gov. (n.d.). Catastrophic health plans.
Healthcare.gov. (n.d.). Glossary.
Healthcare.gov. (n.d.). Hardship exemptions, forms and how to apply.
Healthcare.gov. (n.d.). Healthcare.gov.
Healthcare.gov. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more.
Healthcare.gov. (n.d.). Preventive health services.
Healthcare.gov. (n.d.). Quality ratings of health plans.
Healthcare.gov. (n.d.). The ‘metal’ categories: bronze, silver, gold and platinum.
Healthcare.gov. (n.d.). Your total costs for health care: Premium, deductible & out-of-pocket costs.
KFF. (n.d.). Marketplace average benchmark premiums.
