ACA Plans Explained: What You Need to Know

Marketplace health insurance plans under the Affordable Care Act are grouped into four "metal" categories: Bronze, Silver, Gold and Platinum. These categories are based on how you and your plan share costs—not the quality of care. Bronze plans usually pay about 60% of your covered costs and you pay 40%, so they have the lowest monthly premiums and the highest deductibles. Silver plans generally pay about 70% of costs and you pay 30%, with moderate premiums and deductibles. Gold plans cover roughly 80% of costs with higher premiums but lower deductibles and copays. Platinum plans pay around 90% of costs; they have the highest premiums but the lowest out‑of‑pocket costs.

No matter which metal tier you choose, all Marketplace plans must cover the same 10 essential health benefits, including preventive services, hospital care and prescription drugs. The difference lies in how much you pay when you get care. Depending on your income, you may qualify for premium tax credits or cost‑sharing reductions that lower your monthly costs and your out‑of‑pocket expenses. Cost‑sharing reductions are only available on Silver plans and can significantly reduce your deductible, copayments and out‑of‑pocket maximum.

When comparing plan categories, think about how often you expect to use medical services. If you’re generally healthy and want to keep your monthly premiums as low as possible, a Bronze plan might make sense—just be prepared to pay more when you need care. Silver plans are a balanced option and may be the best value if you qualify for extra savings. Gold and Platinum plans cost more each month but may be worthwhile if you expect frequent doctor visits, need regular prescriptions or simply want peace of mind with lower costs when you receive care. Fortura Insurance Agency can help you evaluate your options and find the right balance of premiums and coverage for your needs.