Learn about the health plan types

Plan Types

You’ll notice many types of plans when you’re trying to find the right plan for yourself and your family. We’ve explained what it all means below.

 

 

Plans by Metal Level

  • Bronze: Bronze plans tend to have the lowest monthly premiums. Bronze plans must cover an average of 60% of all your covered out-of-pocket costs while you are responsible for the remaining 40%. Bronze plans qualify for Tax Credits.

  • Silver: Silver plans tend to have the second lowest monthly premiums. Silver plans must cover an average of 70% of all your covered out-of-pocket costs while you are responsible for the remaining 30%. Silver plans qualify for both Tax Credits and Cost Sharing subsidies. These are the only types of plans to qualify for cost sharing reduction.

  • Gold: Gold plans tend to have the second highest monthly premiums. Gold plans must cover an average of 80% of all your covered out-of-pocket costs while you are responsible for the remaining 20%. Gold plans qualify for Tax Credits.

  • Platinum: Platinum plans tend to have the highest monthly premiums. Platinum plans must cover an average of 90% of all your covered out-of-pocket costs while you are responsible for the remaining 10%. Platinum plans qualify for Tax Credits.

  • Catastrophic Coverage: Catastrophic health plans are the least expensive plans you can get that count as minimum essential benefits. If you are under 30 or obtained a “hardship exemption” you qualify for high deductible, low premium, catastrophic plans. These have extremely high out-of-pocket costs.

 

 

 

Plans by Network Type

  • Exclusive Provider Organization (EPO): These types of plans cover care provided by doctors, specialists, or hospitals exclusive to the plan’s network (except in an emergency). As a member of this plan, you may not need a referral from your primary care doctor to see a specialist in the plan’s network.

  • Health Maintenance Organization (HMO): These types of plans limit coverage to care from only the doctors in the plan’s network. It generally won't cover out-of-network care except in an emergency. HMOs often require members to get a referral from their primary care physician in order to see a specialist.

  • Point of Service (POS): These types of plans allow you to pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. Members can still seek out-of-network care, but will typically pay more. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

  • Preferred Provider Organization (PPO): These types of plans allow you to pay less if you use providers in the plan’s network. However, you can use doctors, hospitals, and providers outside of the network without a referral but potentially at higher costs.

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*The advertised prices under $50/mo is based on a study for the Department of Health and Human Services which found that 46% of people paid $50 or less for an Obamacare Plan after subsidies (Burke, Misra, and Sheingold, p.2, 2014). The full study can be found here:

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