Metal tiers & plan types

The metal tiers

Marketplace plans are sorted into tiers named for metals — Bronze, Silver, Gold, and Platinum — plus a Catastrophic option for people under 30 or with a hardship exemption. The metal is a shorthand for actuarial value: the share of a typical person’s total medical costs the plan is expected to cover. A Bronze plan covers roughly 60%, Silver about 70%, Gold about 80%, and Platinum about 90%. The rest is what you pay through deductibles, copays, and coinsurance. So the higher the metal, the more the plan pays when you get care — and the higher the monthly premium in return.

Catastrophic plans sit below Bronze: very low premiums, a very high deductible, and protection mainly for a worst-case year. One useful 2026 change worth knowing: Bronze and Catastrophic plans now qualify as HSA-eligible high-deductible plans, so you can pair them with a tax-advantaged Health Savings Account.

Picking a tier by how you use care

The right tier depends less on your budget than on how much care you expect to use. If you’re healthy and rarely see a doctor, a Bronze plan keeps your monthly cost low and you absorb the occasional bill. If you have a chronic condition, take regular medications, or expect surgery or a baby, a Gold or Platinum plan costs more each month but far less each time you get care, which usually comes out ahead.

Silver deserves a separate look. It’s the only tier that carries cost-sharing reductions, which can lower your deductible and copays dramatically if your income is under 250% of the poverty level. For someone who qualifies, a Silver plan with those reductions can end up more generous than a Gold plan — so it’s worth checking your subsidy eligibility before defaulting to the cheapest premium. Our guide to subsidies explains how that works.

Plan types: HMO, PPO, EPO, POS

Alongside the metal tier, every plan has a network type that controls which providers you can see. An HMO keeps costs down by requiring you to stay in-network and, usually, to get a referral from a primary care doctor before seeing a specialist; out-of-network care isn’t covered except in emergencies. A PPO is the most flexible: you can see any provider, in-network or out, without referrals, though out-of-network care costs more — and so does the premium. An EPO is a middle ground that keeps you in-network like an HMO but usually drops the referral requirement. A POS plan blends the two, asking for referrals like an HMO while covering some out-of-network care like a PPO.

Whichever type you choose, the single most important check is whether your doctors and the hospital you’d want are in that plan’s network. A low premium isn’t a bargain if it means leaving your physician.

Same benefits, different trade-offs

It helps to remember what doesn’t change. Every Marketplace plan, at every metal tier and network type, covers the same ten essential health benefits and can’t turn you down or charge more for a pre-existing condition. So the comparison really comes down to two dials: the metal tier sets how you and the plan split costs, and the network type sets how much freedom you have in choosing providers. When you’re ready to weigh real plans on both, you can compare them through PlanMatch Health.