Coverage Levels (Health Insurance)

Labels for private health coverage options that give people an idea how much they would have in out-of-pocket expenses, such as copayments, coinsurance, and deductibles, when they use covered services. Plans that are the same coverage level should have roughly the same out-of-pocket expenses.

There are four different levels of plans available to most people:

  1. Platinum plans have the highest monthly premiums and the lowest out-of-pocket expenses when you get medical care.
  2. Gold plans have slightly lower premiums and slightly higher out-of-pocket expenses when you get medical care.
  3. Silver plans have lower premiums. The out-of-pocket expenses for medical services depend on your family’s income; if it is at or below 250% of the Federal Poverty Guidelines (FPG), the out-of-pocket expenses may be as low as a gold or platinum plan.
  4. Bronze plans have the lowest monthly premiums and the highest out-of-pocket expenses when you get medical care.

You may see plans with percentages ranging from as low as 60% for Bronze plans to as high as 90% for Platinum plans. A lower percentage means the plan has higher out-of-pocket expenses when you get medical care, while a higher percentage means the plan has lower out-of-pocket expenses. Plans with lower percentage ratings usually have lower monthly premiums. Note: These percentages do not tell you exactly what percentage of your family's expenses your plan will pay for. They are based on averages for thousands of families and how much your plan actually ends up paying for your family could be much higher, or much lower, than what the percentage rating says, depending on the services your family needs.