You have choices when you shop for health insurance. If you’re buying from your state’s Marketplace or from 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 are under 30, you may also be able to buy a high-deductible, catastrophic plan.
How are the plans different? Each one pays a set share of costs for the average enrolled person. The details can vary across plans. In addition, deductibles — the amount you pay before your plan picks up 100% of your health care costs — vary according to plan, generally with the least expensive carrying 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 have reached a very high deductible ($7.350 in 2018). Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.
You will also see insurance brands associated with the care levels. Some large 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 (EPOs)
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 differ. Being familiar with the plan types can help you pick one to fit your budget and meet your health care needs. To learn the specifics about a brand’s particular health plan, look at its summary of benefits.
Health Maintenance Organization (HMO)
An HMO delivers all health services through a network of healthcare providers and facilities. With an HMO, you may have:
The least freedom to choose your health care providers
The least amount of paperwork compared to other plans
A primary care doctor to manage your care and refer you to specialists when you need one so the care is covered by the health plan; most HMOs will require a referral before you can see a specialist.