Health insurance plans are grouped into metal tiers. Each metal tier represents how you and your insurance provider will split the costs of medical care. At the end of the day, selecting the right one comes down to which one works the best for you.
Before you start shopping for health insurance plans, go through this quick checklist:
Those with a tight estimated yearly household budget may qualify for state-sponsored subsidies to help make your medical expenses more affordable. For example, If you’re between 100% and 250% of the federal poverty level and choose only a Silver plan, you may qualify for additional tax subsidies to help reduce out-of-pocket costs like deductibles, copays, coinsurance, and annual maximums in addition to receiving premium tax credits.
Consider your age, health condition, and prescription medication needs. If you know you’ll be visiting the doctor often, springing for a more expensive plan is likely worth it.
Learn about how insurance plans work, including the differences between premiums, deductibles and copays.
Make sure the insurance network you go with covers them. HealthBird makes this part a breeze.
Most health insurance companies offer plans structured in metal tiers, from bronze to platinum. The more valuable the metal, the more coverage is included. The percentage of total average costs for covered benefits is known as the plan's actuarial value. If a plan advertises an actuarial value of 80%, for example, you’d be responsible for paying an average of 20% of all covered benefits.
The figures aren’t exact, varying from year to year depending on which services you use, but it provides a solid estimate of how much you can expect to pay for care. Typically, policies are structured with the following coverage:
Platinum plans: 90% coverage, you pay 10%
Gold plans: 80% coverage, you pay 20%
Silver plans: 70% coverage, you pay 30%
Bronze plans: 60% coverage, you pay 40%
Catastrophic plans: Similar to a bronze plan, only with even lower premiums
Different insurance companies may offer slightly different percentages in each tier, but you get the idea. Just read the details of any plans you’re considering to see the exact breakdown. Keep in mind that metal tiers do not relate to the quality of care, but the cost of care. You’ll get the same care with a silver plan as with a platinum plan– You’ll just pay more out of pocket.
Plans in higher metal tiers offer better coverage, but they also cost more per month. The monthly premium of a Gold plan is higher than that of a Bronze plan, but you’ll pay less at the doctor’s office when that pesky cold turns into a nagging sinus infection. The most expensive plan isn’t always the best fit, however. There’s nothing wrong with choosing a lower-tier plan with a lower monthly premium, as long as you plan ahead for higher medical expenses when you do need care.
Silver plans are known as the “benchmark” option because of their moderate monthly premiums and moderate costs when you need care. If you want to qualify for cost-sharing reductions, like reduced deductibles, copays, and coinsurance, you must choose a silver plan.
Way, way better. Trust us. Catastrophic health insurance plans, also known as minimum coverage plans, are like the secret fifth option outside of the traditional tier system. They’re designed to protect young people in good health from worst-case health scenarios. They have the lowest premiums of all, and they have bare-bones coverage, but they’ll keep you from getting crushed by an avalanche of medical debt if you get seriously ill.
The exact coverage varies from state to state, but a common coverage breakdown looks something like this:
These plans are usually available for people under the age of 30, but if you’re 30 or over, you can buy catastrophic coverage if you have a state-approved exemption. That said, it might be better to consider a bronze plan instead. The premium of a bronze plan is often similar to that of catastrophic coverage, and your deductible is usually lower with a bronze plan. You might also qualify for a cost reduction on a Bronze plan if you meet certain income requirements, while no discounts are offered for catastrophic plans.
Any plan you choose will have a monthly premium. Thanks to the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, monthly payments will reach record affordability this coming year. New financial assistance with premiums means that 4 out of 5 people will be able to find a plan for $10 or less per month. Wow! If you qualify for a premium tax credit — also known as a premium subsidy — this financial assistance will reduce your monthly bill.
The total costs of each plan will depend on what kind of plan you choose and how much you access care. Your monthly premium for the coverage year remains the same unless you have a change known as a qualifying life event. Beyond your monthly premium, there are other out-of-pocket expenses including deductibles, copayments and coinsurance. You can get all the details on the differences in our previous journal post.
Once you hit an annual limit, known as the out-of-pocket maximum, all covered services will be paid 100% by your insurance provider. For 2023 marketplace plans, the out-of-pocket maximum is $9,100 for an individual and $18,200 for a family.
As a rule of thumb, if you use your health benefits frequently or have a pre-existing condition, springing for a higher-tier plan is worth it. If you only go for an annual physical unless you’re on the brink of death, a lower-tier plan may be a better match.
Step 1: Make a HealthBird account. It’ll only take a few minutes, we promise.
Step 2: Answer a few easy questions, and let our insurance search AI, Costa, do its magic. It’s like a virtual assistant available 24/7, and it’s free.
Step 3: Review your insurance quotes and weigh your options. You can always save your quotes for later if you need time to think them over.
Step 4: Reach out for help if you’re on the fence! Our concierge team is available seven days a week to point you in the right direction.
Step 5: Buy a plan, and get coverage in 2023. Plans starting as low as $0/month*. It’s that easy.
Step 6: Manage your coverage and care from your smartphone, all in the intuitive HealthBird app.
It’s that easy. To try out HealthBird, make an account in minutes, or contact us with questions.
** Individual exchange plans only if you qualify. Not an actual consumer quote. Premium rates vary based on state, income, and family size. Additionally, subsidies are subject to qualifications based on factors including but not limited to your state, household income, and household size. Policies have limitations and exclusions. Reflekt Technologies, Inc., DBA HealthBird, This website is operated by Reflekt Technologies, Inc. (DBA “HealthBird”); and insurance brokerage services are provided through Insurance Bird, LLC of Florida (“Insurance Bird”); NPN: 20422094