You have choices when you shop for health insurance. If you’re buying from your state’s Marketplace or from an insurance broker, you’ll choose from health plans organized by the level of benefits they offer: 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 be able to buy a high-deductible, catastrophic plan.
How are the plans different? Each one pays a set share of costs for the average enrolled person. The details can vary across plans. In addition, deductibles — the amount you pay before your plan pays any of your health care costs — vary according to plan, generally with the least expensive carrying the highest deductible. . No matter what level of plan you choose, they all have the same out-of-pocket maximum ($9,450 in 2024). After you spend this amount on copayments, coinsurance, and deductibles, your plan will pay for 100% of your covered medical expenses.
- Platinum: covers 90% on average of your medical costs; you pay 10%
- Gold: covers 80% on average of your medical costs; you pay 20%
- Silver: covers 70% on average of your medical costs; you pay 30%
- Bronze: covers 60% on average of your medical costs; you pay 40%
- Catastrophic: Catastrophic policies pay after you have reached a very high deductible ($9,450 in 2024). 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.
Each insurance brand may offer one or more of these four common types of plans:
- Health maintenance organizations (HMOs)
- Preferred provider organizations (PPOs)
- Exclusive provider organizations (EPOs)
- Point-of-service (POS) plans
Health Maintenance Organization (HMO)
An HMO delivers all health services through a network of healthcare providers and facilities. With an HMO, you may have:
- The least freedom to choose your health care providers
- 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 may have to pay the full bill yourself. Emergency services at an out-of-network hospital must be covered at in-network rates, but non-participating doctors who treat you in the hospital can bill you.
Preferred Provider Organization (PPO)
With a PPO, you may have:
- A moderate amount of freedom to choose your health care providers — more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist.
- Higher out-of-pocket costs if you see out-of-network doctors vs. in-network providers
- More paperwork than with other plans if you see out-of-network providers
What doctors you can see. Any in the PPO’s network; you can see out-of-network doctors, but you’ll pay more.
Exclusive Provider Organization (EPO)
With an EPO, you may have:
- A moderate amount of freedom to choose your health care providers — more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist.
- No coverage for out-of-network providers; if you see a provider that is not in your plan’s network – other than in an emergency – you will have to pay the full cost yourself.
- Lower premium than a PPO offered by the same insurer
What doctors you can see. Any in the EPO’s network; there is no coverage for out-of-network providers.
Point-of-Service Plan (POS)
A POS plan blends the features of an HMO with a PPO. With POS plan, you may have:
- More freedom to choose your health care providers than you would in an HMO
- A moderate amount of paperwork if you see out-of-network providers
- A primary care doctor who coordinates your care and who refers you to specialists
What doctors you can see. You can see in-network providers your primary care doctor refers you to. You can see out-of-network doctors, but you’ll pay more.
Catastrophic Plan
If you are under the age of 30 you can purchase a catastrophic health plan. With a catastrophic health plan you may have:
- Lower premium
- 3 primary care visits before the deductible applies
- Free preventive care, even if you haven’t met the deductible
What doctors you can see. Any in the plan’s network; individual plans may have additional rules on specialists.
High-Deductible Health Plan With or Without a Health Savings Account
Similar to a catastrophic plan, you may be able to pay less for your insurance with a high-deductible health plan (HDHP). With an HDHP, you may have:
- One of these types of health plans: HMO, PPO, EPO, or POS
- Higher out-of-pocket costs than many types of plans; like other plans, if you reach the maximum out-of-pocket amount, the plan pays 100% of your care.
- A health savings account (HSA) to help pay for your care; the money you put in an HSA is not taxed and can be used tax-free on eligible medical expenses. In order to have an HSA, you must be enrolled in an HDHP.
What doctors you can see. This varies depending on the type of plan — HMO, POS, EPO, or PPO