QUESTION

I notice marketplace plans are labeled “bronze,” “silver,” “gold,” and “platinum.” What does that mean?

Individuals with no coverage | Comparing Plans: Benefits and Costs
ANSWER

Plans in the marketplace are separated into categories — bronze, silver, gold, or platinum — based on the amount of cost-sharing they require. Cost-sharing refers to out-of-pocket costs like deductibles, co-pays and coinsurance under a health plan. For most covered services, you will have to pay (or share) some of the cost, at least until you reach the annual out-of-pocket limit on cost-sharing. The exception is for preventive health services, which health plans must cover entirely.

In the marketplace, bronze plans will generally have the highest deductibles and other cost-sharing. Silver plans will require somewhat lower cost-sharing, but this may not always be the case. If you are deciding between a bronze and silver plan, you will want to determine what the cost-sharing amounts are for the services you would use under each plan. Gold plans will have even lower cost-sharing. Platinum plans will have the lowest deductibles, co-pays and other cost-sharing. In general, plans with lower cost-sharing will have higher premiums, and vice versa. Keep in mind, however, that if you qualify for cost-sharing reductions, you must enroll in a silver plan to obtain cost-sharing reductions that lower your out-of-pocket costs. (45 C.F.R. § 156.130; 45 C.F.R. § 147.130; 45 C.F.R. § 156.140).

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