Learn Before You Choose

Understanding Health Insurance

Marketplace plans come in four "metal" tiers — and the names have nothing to do with quality. Here's what they actually mean.

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The Metal Tiers, Plainly
Every ACA Marketplace plan falls into one of four tiers. They don't describe how "good" the doctors are — they describe how the costs are split between you and the plan.
Lowest Premium
Bronze
The plan typically pays about 60% of costs, you pay about 40%. Lower monthly premium, higher costs if you actually need care.
Balanced
Silver
Roughly a 70/30 split. Also the only tier eligible for extra savings on deductibles and copays, if you qualify based on income.
Higher Premium
Gold
About an 80/20 split. Higher monthly cost, but you pay less out of pocket when you actually use care.
Highest Premium
Platinum
Roughly 90/10. The highest monthly premium, but the least you'll pay when you need frequent or expensive care.
Words You'll Hear a Lot
A few terms that come up in almost every Marketplace conversation.
Premium Tax Credit
A subsidy, based on your income, that lowers your monthly premium. Many people qualify without realizing it — it's worth checking before assuming a plan is unaffordable.
Network
The specific group of doctors and hospitals a plan works with. Going outside the network can cost significantly more, or not be covered at all, depending on the plan type.
Special Enrollment
A window outside the normal enrollment season where you can still sign up or make changes — usually triggered by a life event like losing other coverage, moving, or a change in household.
Essential Benefits
A set of services every ACA Marketplace plan is required to cover, including preventive care, emergency services, and prescription drugs — so the basics are protected no matter which tier you choose.
Two Common Paths
Most people get health coverage one of two ways.

Marketplace (ACA) Plan

Purchased directly, often with income-based subsidies that lower the cost. A good fit if you're self-employed, between jobs, or your employer doesn't offer coverage.

Employer-Sponsored Plan

Offered through your job, often with the employer covering part of the premium. Worth comparing against Marketplace options — sometimes a Marketplace plan actually costs less.

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Not all plans available in all states. Coverage varies by plan. This is not a guarantee of coverage.