You have choices when you shop for health insurance. If you're buying from your state's Marketplace, the first way you'll see health plans organized is by their level of care: 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 see a high-deductible, catastrophic plan listed.
How are the plans different? Each one pays a set share of costs for the average enrolled person. The details can vary across plans.
- Platinum: covers 90% of your medical costs; you pay 10%
- Gold: covers 80% of your medical costs; you pay 20%
- Silver: covers 70% of your medical costs; you pay 30%
- Bronze: covers 60% of your medical costs; you pay 40%
- Catastrophic: This plan only covers your medical expenses after you have reached the annual deductible of $6,350 for an individual or $12,700 for a family. 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. If you are buying insurance from your employer, the brand name might be the first category you see.
Each insurance brand may offer one or more of these four common types of plans:
- Health maintenance organizations (HMOs)
- Preferred provider organizations (PPOs)
- Point-of-service (POS) plans
- High-deductible health plans (HDHPs) 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 health services through a network. With an HMO, you may have:
- The least freedom to choose your health care providers.
- Predictable out-of-pocket costs.
- 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.
What doctors you can see. Any in your HMO's network. If you see a doctor who is not in the network, you'll have to pay the bill yourself -- unless it's an emergency.
What you pay.
- Premium: This is the cost you pay each month for insurance.
- No deductible.
- Copays for each type of care.
Paperwork involved. No claim forms. You won't get bills for care that is covered.
Preferred Provider Organization (PPO)
With a PPO, you may have:
- A moderate amount of freedom to choose your health care providers -- more than with an HMO. You do not have to get a referral from a primary care doctor to see a specialist.
- Generally higher out-of-pocket costs than with an HMO.
- More paperwork than with other plans if you see out-of-network providers.
- The ability to manage your own health.