What Is the Affordable Care Act’s Silver Health Plan?
Key takeaways:
Affordable Care Act (ACA) plans are organized into “metal tiers” — bronze, silver, gold, and platinum — that determine how you and the plan will share the costs of care.
Silver health plans have the second-lowest monthly costs. A silver plan has a moderate monthly premium with moderate out-of-pocket expenses when you access care.
A silver plan is known as the “benchmark plan” because of its middle-of-the-road expenses when compared with the marketplace’s platinum, gold, and bronze plans.
You must choose a silver plan to qualify for cost-sharing breaks known as “extra savings” that will reduce your deductible, copayments, and coinsurance.
Table of contents
The Affordable Care Act (also known as the ACA, or Obamacare) marketplace presents health plans in four “metal tiers.” Those metal categories — bronze, silver, gold, and platinum — bundle plans based on how you and your plan will split the costs of care. Bronze plans have the lowest monthly premiums and the highest out-of-pocket costs when you need care. On the other end of the spectrum, platinum plans have the highest premiums and the lowest expenses when you receive care.
Silver plans offer moderate premiums with moderate charges for deductibles, copayments, and coinsurance. A silver health plan is the most common choice for people who buy health coverage on the ACA marketplace. It’s also the plan you must choose to receive “extra savings” that reduce out-of-pocket costs, such as your deductible, copays, and coinsurance.
What does a silver plan cover?
Silver plans and all other ACA marketplace plans must cover 10 essential health benefits, which are:
Emergency services
Hospitalization
Laboratory services
Mental health and substance use disorder services
Outpatient care
Pediatric services
Pregnancy, maternity, and newborn services
Prescription drugs
Preventive care, wellness services, and chronic disease management
Rehabilitative and habilitative services and devices
Know your metal tiers: Affordable Care Act (ACA) plans are grouped into metal tiers — bronze, silver, gold, and platinum — to represent how you will split the cost of care with your health plan.
More people qualify for Obamacare than ever: You’re eligible for ACA plans if you have a household income between 100% and 400% of the federal poverty level (FPL). And you may qualify for a premium tax credit even if you earn more than 400% of the FPL.
Don’t miss open enrollment: Most people sign up for or renew their ACA plans during the fall open enrollment period, but certain life events can qualify you for a special enrollment period any time of the year.
What are the benefits of the silver health plan?
You must choose a silver health plan if you qualify for cost-sharing reductions known as “extra savings” and want to receive them to reduce your out-of-pocket costs when you access care.
If you enroll in a bronze, gold, or platinum plan, you’ll still qualify for the premium subsidy, but you won’t get the extra savings on out-of-pocket costs.
How much does the silver health plan cost?
Your monthly premium for a silver plan depends on your income, how many people are covered, and which plan you choose.
Prescription Savings Are Just the Beginning
See what other benefits you qualify for—from cashback cards to cheaper insurance.
You may qualify for a premium subsidy, also known as premium tax credit, even with a household income above 400% of the federal poverty level. Because of the premium subsidies, 80% of ACA enrollees can get a health plan for $10 a month or less in 2025.
Depending on how much a premium subsidy reduces your monthly costs, you may be better off choosing a gold or platinum plan because these higher-value plans lower out-of-pocket costs when you need care. You can use KFF’s health insurance marketplace calculator to estimate your premiums and subsidies on the ACA marketplace.
The total costs of each plan include your monthly premium and these out-of-pocket expenses when you access care:
Deductible
A deductible 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 preventive health services provided without you meeting a deductible or other out-of-pocket expenses.
Copayments and coinsurance
These are out-of-pocket 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 in-network, covered services in a plan year. After your deductible, copayments, and coinsurance combined reach this amount, all covered services in a plan year are paid 100% by the insurance company. Marketplace plans have an out-of-pocket maximum of $9,200 for an individual and $18,400 for a family for the 2025 plan year.
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Silver vs. bronze, gold, and platinum plans
ACA health plans fall into four metal tiers, or value categories:
Bronze: These plans have the lowest monthly premiums but the 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, which are extra savings on out-of-pocket expenses such as deductibles, copayments, and coinsurance.
Gold: These plans have high monthly premiums but low costs when you need care.
Platinum: These plans have the highest monthly premiums and the lowest costs when you need care.
Here is the estimated average cost-sharing for a typical population.
Plan category | Your insurance company pays | You pay |
Bronze | 60% | 40% |
Silver | 70% | 30% |
Silver with extra savings | 73% to 96% (depending on how much you are qualified to receive) | No more than 27% |
Gold | 80% | 20% |
Platinum | 90% | 10% |
Some states require health plans to be even more uniform, to help customers compare them. These are standardized individual health plans. Each will have an identical deductible, copayment, and coinsurance for specific services.
Should I avoid the silver health plan?
The silver health plan may be the wrong choice for you if you expect to receive a lot of medical care and would not qualify for extra savings. A gold plan may be better for you or your family. That’s because the premium subsidy may make the premium of a gold or platinum plan affordable for you. Gold and platinum plans have the lowest costs when you need care.
How do I sign up for the silver health plan?
ACA enrollment involves completing an application, choosing a plan, and paying your first premium, if needed. The entry point is Healthcare.gov, the national marketplace website — which may forward you to a local site if your state has its own marketplace.
If you have questions, call the Marketplace Call Center at 800-318-2596. This line is available 24 hours a day, 7 days a week — excluding holidays. And the “find local help” tool can help you locate an ACA navigator in your area to help you evaluate your options. The services of the call center and ACA navigators are free.
Frequently asked questions
Sort of. Open enrollment in most states runs from November 1 to January 15 annually. Some states extend their deadlines to the end of January, and Idaho typically has an earlier deadline in mid-December.
You may be eligible to choose a catastrophic health plan if you qualify for a hardship exemption. A hardship can include an affordability exemption for marketplace premiums or job-based insurance that’s too costly for you. Catastrophic health plans are also available to people under 30. If you cannot afford an ACA plan, see if you qualify for the state-based insurance program called Medicaid. Your Obamacare application can help you determine if you qualify for Medicaid.
Premium subsidies are monthly discounts that reduce the cost of having an ACA health insurance plan. They show up as tax credits based on your estimated income in a coverage year. If your actual income is more than the estimate, this may result in a higher tax bill.
The bottom line
Selecting a silver health plan on the ACA marketplace may be the best choice for you and your family. Plans in this “metal tier” are the most common choice for consumers. Silver plans have moderate monthly premiums and moderate out-of-pocket costs when you receive care. Premium subsidies mean that you may pay $0 or nearly nothing for your monthly premium. If you qualify for extra savings on out-of-pocket expenses, you must choose a silver plan to receive them.
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References
Centers for Medicare & Medicaid Services. (2024). Marketplace 2025 open enrollment fact sheet.
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Healthcare.gov. (n.d.). Deductible.
Healthcare.gov. (n.d.). Essential health benefits.
Healthcare.gov. (n.d.). Federal poverty level (FPL).
Healthcare.gov. (n.d.). Health benefits & coverage: Preventive health services.
Healthcare.gov. (n.d.). Health coverage exemptions: Forms & how to apply: Health coverage exemptions, forms & and how to apply.
Healthcare.gov. (n.d.). How to pick a health insurance plan: Catastrophic health plans.
Healthcare.gov. (n.d.). How to pick a health insurance plan: The health plan categories: Bronze, Silver, Gold & Platinum.
Healthcare.gov. (n.d.). How to pick a health insurance plan: Your total costs for health care: Premium, deductible & out-of-pocket costs.
Healthcare.gov. (n.d.). Out-of-pocket maximum/limit.
Healthcare.gov. (n.d.). Premium.
Healthcare.gov. (n.d.). Premium tax credit.
Healthcare.gov. (n.d.). Saving money on health insurance: Cost-sharing reductions.
Healthcare.gov. (n.d.). Silver health plan.
KFF. (n.d.). Health insurance marketplace calculator.
Sullivan, J., et al. (2024). Entering their second decade, Affordable Care Act coverage expansions have helped millions, provide the basis for further progress. Center on Budget and Policy Priorities.
