Health Plan Categories
Health plan categories refer to the four types of health insurance plans that are differentiated based on the average percentage of healthcare expenses that will be paid by the plan. Your monthly premium will be low, but you’ll have to pay for most routine care yourself. **Moderate** monthly premium **Moderate** costs when you need care Silver deductibles are usually lower than those of Bronze plans. **Good choice Because each plan is different in terms of deductibles, copayments and coinsurance amounts, your share of the costs may come in the form of a large deductible with low coinsurance (for example, a $4,000 deductible with 10 percent coinsurance) or a small deductible with high coinsurance (such as a $1,500 deductible with 30 percent coinsurance). Gold and Platinum plans pay more on average toward healthcare expenses, while Silver and Bronze plans pay less. In addition to the four metallic coverage tiers, a catastrophic level is available to people under age 30 and to certain people over age 30 who are granted hardship exemptions based on income and other circumstances that would prevent them from getting a Bronze, Silver, Gold or Platinum plan.
What is Health Plan Categories
Health plan categories refer to the four types of health insurance plans that are differentiated based on the average percentage of healthcare expenses that will be paid by the plan. In the United States, health insurance plans are offered in four actuarial levels: Bronze, Silver, Gold, and Platinum. The level defines the amount of expenses each type of plan covers.
Understanding Health Plan Categories
The higher the actuarial value (i.e. Gold and Platinum), the more that health plan category will pay on average toward healthcare expenses. The lower the actuarial value (Bronze and Silver), the less that health plan category will pay. The typical actuarial values for the four coverage tiers are:
All plans cover the same set of essential health benefits. Because each plan is different in terms of deductibles, copayments and coinsurance amounts, your share of the costs may come in the form of a large deductible with low coinsurance (for example, a $4,000 deductible with 10 percent coinsurance) or a small deductible with high coinsurance (such as a $1,500 deductible with 30 percent coinsurance).
With all health plans, consumers pay a monthly insurance premium whether or not they use healthcare services. Premiums are typically higher for plans that pay more of your medical expenses when you receive care, such as Gold and Platinum plans. In general, premiums are also higher for plans that have lower deductibles and lower coinsurance amounts.
In addition to the four metallic coverage tiers, a catastrophic level is available to people under age 30 and to certain people over age 30 who are granted hardship exemptions based on income and other circumstances that would prevent them from getting a Bronze, Silver, Gold or Platinum plan.
There are 14 reasons for which someone may be granted a hardship exemption, including being homeless; having substantial property damage resulting from fire, flood or other disaster; and filing for bankruptcy in the past three years.
Comparing Health Plan Categories
Platinum
Related terms:
Actuarial Value
Actuarial value is the percentage of total average costs for covered benefits that will be paid by a health insurance plan. read more
Catastrophic Health Insurance
Catastrophic health insurance is medical coverage open to people under 30 and adults of any age who have a government-approved general hardship exemption. read more
Cost-Sharing Reductions (CSRs)
Cost-sharing reductions are a type of federal subsidy distributed as discounts that help reduce out-of-pocket costs for health care expenses. read more
High-Deductible Health Plan (HDHP)
A high-deductible health plan is health insurance with a high minimum deductible for medical expenses that must be paid before insurance coverage kicks in. read more
Health Insurance
Health insurance is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. read more
Insurance Premium
An insurance premium is the amount of money an individual or business pays for an insurance policy. read more
Medicare
Medicare is a U.S. government program providing healthcare insurance to individuals 65 and older or those under 65 who meet eligibility requirements. read more
Out-of-Pocket Maximum
Health insurance plans cap what you and your family spend each year for covered healthcare. Here's what an out-of-pocket maximum is and how it works. read more