The four tiers
HealthCare.gov sorts Marketplace plans by how the plan and you split the costs of covered services. Its percentages are estimates of the two shares, and the page says the actual costs you pay vary by plan.
| Tier | Plan pays | You pay | Deductible is generally |
|---|---|---|---|
| Bronze | about 60% | about 40% | High |
| Silver | about 70% | about 30% | Moderate |
| Gold | about 80% | about 20% | Low |
| Platinum | about 90% | about 10% | Low |
| Silver with extra savings | 73 to 94% | 6 to 27% | Low |
Two things the table does not say. First, the share is an average across covered services, not the coinsurance on each bill; a single bill depends on the plan's deductible, copayments and coinsurance. Second, the tier says nothing about the premium or the network. Whether a plan is an HMO, PPO, EPO or POS plan, and which doctors it includes, is a separate choice you check plan by plan. All plans in every category must cover the same 10 essential health benefits, including preventive services.
The tier says how costs are shared, not which doctors you can see; that depends on the plan type, compared in HMO vs PPO vs EPO vs POS.
A light year and a heavy year
To see what the shares mean in dollars, apply them to two years of covered costs: $3,000 for a light year and $30,000 for a heavy one. Your share is capped at the 2026 out-of-pocket limit of $10,600 for an individual, the most a Marketplace plan may set. This is a sketch using only the average shares; a real plan's deductible and copays move the numbers, and premiums come on top.
| Tier | Your share of $3,000 | Your share of $30,000 |
|---|---|---|
| Bronze | $1,200 | $10,600 (capped) |
| Silver | $900 | $9,000 |
| Gold | $600 | $6,000 |
| Platinum | $300 | $3,000 |
| Silver with extra savings | $180 to $810 | $1,800 to $8,100 |
In the light year the tiers are $900 apart from Bronze to Platinum. In the heavy year the gap between Gold and Bronze alone is $4,600, and Bronze already hits the cap. In practice a light year on a high-deductible Bronze plan often costs you more than 40 percent, because most small bills fall below the deductible, while a heavy year is cut off by the maximum. The deductible vs out-of-pocket maximum guide walks a single plan through a year bill by bill.
When a higher tier pays for itself
HealthCare.gov's advice is to compare total yearly costs, not premiums alone: twelve premiums plus deductibles, copayments and coinsurance, up to the out-of-pocket maximum. A higher tier is worth it when the care it covers is more than the extra premium. Using the average shares, the break-even point is the extra yearly premium divided by the extra share the plan pays.
Say a Gold plan costs $100 a month more than a Bronze plan. That is $1,200 a year, and Gold pays about 20 points more of covered costs, so Gold comes out ahead once a year's covered costs pass about $6,000. For Gold against Silver, 10 points apart, the same premium gap needs $12,000. The percentage calculator handles the division for your own quotes, and the budget planner shows whether the higher premium fits your month. On HealthCare.gov, the plan preview can add an estimated yearly cost for a low, medium or high level of care to each plan.
Silver and the extra savings
Cost-sharing reductions, called extra savings on HealthCare.gov, are a discount that lowers your deductible, copayments, coinsurance and out-of-pocket maximum. HealthCare.gov's example: a Silver plan's $750 deductible could drop to $300 or $500, a $30 visit copay to $20 or $15, and a $5,000 out-of-pocket maximum to $3,000. You only get them if you enroll in a Silver plan; the premium tax credit, by contrast, works on any tier.
The federal rule, 45 CFR 155.305(g), sets the income limit at 250 percent of the federal poverty level, with three steps: 100 to 150, 150 to 200 and 200 to 250 percent. The lower your income within the range, the more you save. HealthCare.gov uses the previous year's poverty figures for the next year's Marketplace savings, so the 2026 figures below are the ones for 2027 coverage. The guide to the federal poverty level 2026 has every household size.
| Household | 100% of FPL | 150% | 200% | 250% |
|---|---|---|---|---|
| 1 person | $15,960 | $23,940 | $31,920 | $39,900 |
| 2 people | $21,640 | $32,460 | $43,280 | $54,100 |
| 3 people | $27,320 | $40,980 | $54,640 | $68,300 |
| 4 people | $33,000 | $49,500 | $66,000 | $82,500 |
Figures are for the 48 contiguous states and DC; Alaska and Hawaii are higher. If your income is in this range, compare a Silver plan with savings against Bronze before looking at premiums alone. The premium tax credit guide covers the other half of the help.
Comparing tiers in practice
- Start from last year's care. Count visits, prescriptions and any planned procedure, and decide whether next year looks light, medium or heavy.
- Price the worst case. Twelve premiums plus the plan's out-of-pocket maximum is the most a year of covered in-network care can cost. For a Marketplace plan in 2026 the maximum is at most $10,600 for one person, and a plan can set a lower one.
- Check your income against the Silver range. Below 250 percent of the poverty level, a Silver plan with extra savings can beat Gold on out-of-pocket costs.
- Compare inside one tier too. Deductibles, copays and networks differ between plans of the same metal, and the tier only describes the average split.
Catastrophic plans
A fifth category, where available in your area, is open to people under 30 and to people who qualify for a hardship or affordability exemption. HealthCare.gov describes low premiums and very high deductibles, the same 10 essential health benefits as other plans, free preventive services, and at least 3 primary care visits per year before the deductible is met. Cost-sharing reductions do not apply, and HealthCare.gov notes that if you qualify for the premium tax credit or extra savings, a Bronze or Silver plan may be a better value. All Bronze and Catastrophic plans work with a health savings account; the guide HSA vs FSA has the 2026 limits.
Frequently asked questions
What do the metal tiers mean?
They describe how a Marketplace plan splits the cost of covered care with you on average. HealthCare.gov gives the plan's share as about 60 percent for Bronze, 70 for Silver, 80 for Gold and 90 for Platinum, and says the categories have nothing to do with the quality of care. The actual costs you pay vary by plan.
Does Bronze mean I pay 40 percent of every bill?
No. The 40 percent is an estimate of your share of costs across covered services, not a coinsurance rate. A Bronze plan generally has a high deductible, so in a light year you may pay nearly everything, and in a heavy year the out-of-pocket maximum caps what you pay. The plan's own deductible, copays and coinsurance decide each bill.
Why does Silver matter if I have a low income?
Cost-sharing reductions, which HealthCare.gov calls extra savings, lower your deductible, copayments, coinsurance and out-of-pocket maximum, and you only get them in a Silver plan. With them the plan's share rises to about 73 to 94 percent. The federal rule sets the income limit at 250 percent of the federal poverty level.
Who can buy a catastrophic plan?
HealthCare.gov says catastrophic plans are available to people under 30 and to people who qualify for a hardship or affordability exemption, where such plans are offered. They have lower premiums but very high deductibles, cover at least 3 primary care visits a year before the deductible, and free preventive services.
Can I use a premium tax credit on any tier?
Yes. HealthCare.gov says that if you qualify for the premium tax credit you can get lower premium costs in any metal plan category. The extra savings on out-of-pocket costs are the part limited to Silver.
Sources
- HealthCare.gov: Health plan categories (Bronze, Silver, Gold, Platinum with plan shares of about 60, 70, 80 and 90 percent and deductible levels; Silver with extra savings 73 to 94 percent; percentages are estimates and actual costs vary; categories unrelated to quality; tax credit works in any category; all Bronze and Catastrophic plans work with HSAs)
- HealthCare.gov: Catastrophic health plans (under 30 or a hardship or affordability exemption; very high deductibles; at least 3 primary care visits before the deductible; free preventive services)
- HealthCare.gov: Cost-sharing reductions (Silver plan required; lower deductible, copays and out-of-pocket maximum; the $750, $30 and $5,000 examples; the lower your income in the range, the more you save)
- Code of Federal Regulations, 45 CFR 155.305(g) via Cornell LII (cost-sharing reductions for household income up to 250 percent of the FPL, enrollment in a silver-level plan, the 100 to 150, 150 to 200 and 200 to 250 percent categories)
- HealthCare.gov glossary: Federal poverty level (2025 and 2026 figures by family size; previous year's figures used for the next year's Marketplace savings)
- HealthCare.gov glossary: Out-of-pocket maximum/limit ($10,600 individual limit for 2026; premiums do not count)
- HealthCare.gov: Your total costs for health care (compare premium × 12 plus deductibles, copays and coinsurance, up to the out-of-pocket maximum)
General information based on the sources above, not tax, legal or financial advice.