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You have options when you buy health insurance. Whether you're shopping in your state's Marketplace or through an insurance broker, you'll choose from health plans organized by the level of benefits they offer: bronze, silver, gold, and platinum. Bronze plans have the least coverage and Platinum plans have the most. If you're under 30, you can also buy a high-deductible catastrophic plan.
How are the plans different? Each pays a fixed portion of the costs of the average enrollee. Details may vary between plans. Also, deductibles (the amount you pay before your plan pays 100% of your health care costs) vary by plan, with the cheapest usually having the highest deductible.
Platinum: covers 90% on average of your medical costs; you pay 10%
Gold: covers 80% on average of your medical costs; you pay 20%
Silver: Covers 70% on average of your medical costs; you pay 30%
Bronze: covers 60% on average of your medical costs; you pay 40%
Catastrophic: Catastrophic policies pay after you've met a very high deductible ($8,150 in 2020). Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you haven't met your deductible yet.
You will also see insurance marks associated with levels of care. Some big national brands include Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.
Each insurance brand may offer one or more of these four common types of plans:
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Exclusive Provider Organizations (EPO)
Point of Service (POS) Plans
High Deductible Health Plans (HDHPs), which may be linked to Health Savings Accounts (HSAs)
Take a minute to learn how these plans are different. Being familiar with the types of plans can help you choose one that fits your budget and meets your health care needs. For details about a brand's particular health plan, see its summary of benefits.
Health Maintenance Organization (HMO)
An HMO provides all health services through a network of health care providers and facilities. With an HMO, you may have:
The least freedom to choose your health care providers.
Least amount of paperwork compared to other plans
A primary care physician to manage your care and refer you to specialists when needed for care to be covered by the health plan; most HMOs will require a referral before you can see a specialist.
Which doctors can you see? Anyone in your HMO's network. If you see an out-of-network doctor, you may have to pay the entire bill yourself. Emergency services at an out-of-network hospital must be covered at in-network rates, but nonparticipating doctors who treat you at the hospital may bill you.
What you pay:
Premium: This is the cost you pay each month for insurance.
Deductible: Your plan may require you to pay the amount before care is covered, except preventive care.
Copays and/or coinsurance for each type of care. A copay is a flat fee, like $15, that you pay when you receive care. Coinsurance is when you pay a percentage of the charges for care, for example, 20%. These charges vary by plan and are counted toward your deductible.
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The Center for Health Disparities Solutions is dedicated to the elimination of disparities in health and health care among racial and ethnic populations.
Center for Health Equity, Inc. is dedicated to public service and participatory research that is community-based and focused on the elimination of disparities in health due to race, gender, age, socioeconomic status, or geography
