In the state-run health insurance marketplaces, the government-approved health insurance plans are divided into five tiers: platinum, gold, silver, bronze, and catastrophic. Analysts expect young adults to gravitate towards the bronze and catastrophic plans, which are the lowest-cost options.
Both the bronze and the catastrophic plans cover basic preventative health services including cholesterol tests, immunizations and screenings for depression and alcoholism (a full list is here). Both also cover, to varying degrees, all 10 categories of “essential health services”: hospitalizations, emergency services, ambulatory (outpatient care) services, some maternity and newborn care, pediatric care, vision and dental care for children, mental health and behavioral health treatment, rehabilitative and habilitative services and devices, laboratory services, and chronic care services.
There are some key differences between these two tiers, however. This chart can help you decide which plan may be right for you.
|Bronze Plans||Catastrophic Plans*|
|Available to||Anyone who is eligible to buy a plan on the new health insurance marketplace.||Only those under age 30 or who cannot find coverage for less than 8 percent of their income.|
|Premium tax credits||Individuals making up to $45,960 (or families of 4 making up to $94,200) can use a new kind of upfront tax credit to lower their monthly premiums.||Premium tax credits are not available for catastrophic plans.|
|Covered services||Covers 60 percent of health care costs for the average person, and specified preventive services at no cost.||Covers three primary care visits and specified preventive services before the deductible. Only covers additional services after the plan deductible – $6,350 for a self-only plan or $12,700 for a family plan – has been met.|
|Actuarial Value||Bronze plans will have an “actuarial value” of 60 percent, meaning they will cover 60 percent of all health care costs for the average person.||Catastrophic plans will likely have an actuarial value of less than 60 percent. Catastrophic plans will only cover health care costs (beyond 3 primary care visits and specified preventive services) after the plan deductible has been met.|
|Deductible||Maximum deductible of $6,350 for a self-only plan ($12,700 for a family plan), but actual deductibles are likely to be significantly lower because plans must cover 60 percent of health care costs for the average person.||Deductible will be $6,350 for a self-only plan ($12,700 for a family plan).|
|Out-of-pocket limits||Out-of-pocket expenses are capped at $6,350 for self-only plans ($12,700 for family plans).||Out-of-pocket expenses are capped at $6,350 for self-only plans ($12,700 for family plans).|
|Preventive services||Covers specified preventive services at no cost.||Covers specified preventive services at no cost.|
|Essential health benefits||Covers 10 categories of “essential health benefits.”||Covers 10 categories of “essential health benefits.”|
Chart by Kimberly Leonard, U.S. News staff