In order to be included in the Health Insurance Marketplace, each insurance company can offer four different types of “qualified” health insurance plans– Bronze, Silver, Gold, and Platinum.
A Bronze Plan will cover 60% of health care costs with the consumer responsible for paying 40%. For Silver plans insurance companies pay 70% of costs and the consumer pays 30%. For Gold Plans, the split is 80%-20% and for Platinum the split is 90%-10%. In general, the more the company covers, the more the consumer will pay for the premiums.
For those with income below 250% of the federal poverty level, there are limits on costs that consumers must pay, depending on the plan they choose. For example, someone with income between 100% and 133% of the poverty level who is enrolled in a Silver Plan will pay only approximately 6% of health care costs and the insurance company will pay 94%. Those above 250% of poverty will still pay 30% in a Silver Plan.
This calculator from the University of California-Berkley Labor Center helps consumers estimate their costs both with and without government subsidies.
There is a 5th type of plan that can be offered by insurance companies called a Catastrophic Plan; however, these plans only cover a small number of primary care visits per year, then cover major medical and are only available to those under 30 years old.
Selecting a plan that is a right fit for your healthcare needs and for your household budget is something that deserves careful consideration. The University of Maryland Extension offers helpful consumer resources in their Insuring Your Health area that assist people in thinking through the decision and making a smart choice.
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