What's the Difference Between Gold, Silver and Bronze Plans?

Marketplace Metal Tier Plans: The Difference Between Bronze, Silver and Gold

It’s that time of year when the weather gets chilly, the holidays sweep over us, and the health insurance open enrollment window opens.

For many on the cusp of selecting a Blue Cross Blue Shield of Michigan (BCBSM) or Blue Care Network plan this year, one question prevails: What is the difference between bronze, silver, and gold marketplace insurance plans?

This decision on which plan to choose should be made with three factors in mind: Your current financial situation, your guess as to how much health care you’ll require in the upcoming year, and your risk profile.

Essentially, when it comes to the metal plans, each tier is expected to cover a certain percentage of your major medical expenses during the year. Here is the breakdown by tier, per the Affordable Care Act:

  • Bronze: You pay 40% of your health care costs, BCBSM pays 60%.
  • Silver: You pay 30% of the cost, BCBSM pays 70%.
  • Gold: You pay 20% of the cost, BCBSM pays 80%.

A bronze plan comes with the lowest monthly premium but includes higher out-of-pocket costs and cost-sharing requirements, such as deductibles, coinsurance, and copayments. Of the three, gold plans offer the highest monthly payments and the lowest out-of-pocket costs. Silver, obviously, offers a middle ground compared to the other two tiers.

The amount individuals pay out of pocket depends on how much health care they’ll need in a year. So, while shopping for plans, it’s important to be honest about the type of medical services you’ll need during the year and how much money you’re willing to pay.

For example, if you are a young, athletic male with no medical procedures on the horizon, the bronze plan might make the most sense for you. Say you are in your mid-to-late 20s; a doctor’s appointment for a sore wrist and another for a sinus infection could be the extent of your health care needs next calendar year. If you’re young and fit and rarely need to visit a doctor, it behooves you to open your wallet and pay a little more the few times you do, while paying less each month in premiums.

Conversely, if you’re the parent of a young child with a medical disorder, for instance, and know you are looking at semi-regular appointments, testing, and prescriptions, you’ll probably want to opt for a silver or gold plan so you’re not paying as much money per visit as you would on a bronze plan.

The Department of Health and Human Services sets the maximum amount people would have to pay in a covered year before their insurance plan covers 100% of in-network care. For 2022, the maximum limit is:

  • $8,700 for an individual.
  • $17,400 for other than self-only plans.

Am I eligible for a premium credit?  

Individuals may qualify for financial assistance through the Advanced Premium Tax Credit. Subsidies reduce enrollees’ monthly payments for insurance plans purchased through the marketplace if you are eligible and can be applied to any of the metal tiers. Subsidies must be reported when you submit your taxes.

Expect a 1095 form with all necessary premium tax credit information to complete your return. If at the end of the year you’ve taken more premium tax credit in advance that you’re due based on your final income, you may have to pay back the excess when you file your federal income tax return. If you’ve taken less than you qualify for, you’ll get the difference back.

Can I sign up for an HSA account with a metal tier plan?

You can sign up for a health savings account (HSA) – which is an untaxed account used to pay for qualified medical, pharmacy, dental and vision expenses – if you are covered by a high-deductible health plan.

For 2022, minimum deductibles are unchanged from 2021:

  • $1,400 for self-only plans.
  • $2,700 for family coverages.

Ready to sign up for your BCBSM health insurance plan? Open enrollment for coverage that becomes effective on Jan. 1, 2022, ends Dec. 15. Open enrollment for coverage that goes into effect on Feb. 1., 2022, ends Jan. 15. Check out plans and sign up here.

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