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Five questions, in order

Which plan type, and why that order

Metal level is a cost split, not a quality rating. Ask these five in this order and the shortlist writes itself, usually in under ten minutes.

Which plan type

Five questions, asked in the order that matters

Premium is the fifth most useful question. Work through these in order instead.

Work through the five questions sideways

01

Is your household income under 250% of the federal poverty level?

Cost-sharing reductions attach to silver plans only, and they stop at 250%. This question outranks every other question on the page.

  • Yes, under 250%Start with silver. Your deductible and out-of-pocket maximum are quietly reduced, and below 150% the reduction is dramatic.
  • No, above 250%Silver loses its special power. Compare bronze, silver and gold on total expected cost instead.
02

Do you take a prescription that costs real money every month?

Drug tiers differ by plan, not by metal level. One specialty medication can decide the whole comparison on its own.

  • YesCheck the formulary before the premium. A plan that puts your drug on tier 4 can cost more than a richer plan that puts it on tier 2.
  • NoYou have more freedom to optimise on premium and deductible. Still check that nothing new is on the horizon.
03

Do you expect to use care this year beyond a checkup?

Metal level is a cost-sharing split, not a quality rating. The question is where you want the money to land.

  • Probably notBronze, or subsidised silver if you are under 250%. Preventive care is free on every compliant plan.
  • Yes, a surgery, a birth or a chronic conditionGold, or silver with cost-sharing reductions. Paying more monthly buys a much smaller worst case.
04

Do you want a Health Savings Account?

HSA eligibility is a property of the specific plan, not of the metal level. It requires a qualifying high-deductible health plan.

  • YesFilter to plans marked HSA-eligible. Most are bronze, some are silver, gold almost never qualifies.
  • NoIgnore the HSA label entirely and optimise on network, drug list and total expected cost.
05

Are you under 30, or do you hold a hardship exemption?

Catastrophic plans are restricted, and no premium tax credit can be applied to them.

  • Yes, and I get no subsidyA catastrophic plan is worth pricing. It covers the same essential benefits with three pre-deductible primary care visits.
  • Yes, but I do qualify for a creditSkip catastrophic. A subsidised bronze or silver plan will almost always beat it.

Free tool · metal levels

Metal level is a cost split, not a quality rating

Bronze is not the budget version of gold. Silver behaves oddly on purpose.

No subsidy

Under 30 only

Catastrophic

Below 60% actuarial value

$310a month

A high wall with three free primary care visits in front of it

Who it suits
Under 30, or holding a hardship or affordability exemption. Nobody else may buy it.
Deductible
Equal to the annual out-of-pocket maximum
Out-of-pocket max
Highest allowed
HSA
Not eligible
  • Premium tax credits cannot be applied to a catastrophic plan. The price you see is the price you pay.
  • Covers the same essential health benefits and includes three primary care visits before the deductible.
  • Almost always a worse deal than a subsidised bronze plan if you qualify for any credit at all.
Where this lands in the decision tree

Lowest premium

Bronze

About 60% actuarial value

$95a month

Cheapest monthly, most expensive if you actually need care

Who it suits
Healthy households with savings, or anyone whose credit covers most of the premium and who wants HSA eligibility.
Deductible
High, often several thousand dollars
Out-of-pocket max
At or near the annual legal maximum
HSA
Usually eligible
  • Preventive care is still covered at no cost, as on every compliant plan.
  • Most bronze plans are designed to qualify as high-deductible health plans, which makes an HSA possible.
  • If your credit already covers a silver plan's cost-sharing reductions, bronze is usually the wrong choice.
Where this lands in the decision tree

Check silver first

CSR tier

Silver

70% actuarial value, up to 94% with CSR

$160a month

The only metal level where cost-sharing reductions exist

Who it suits
Anyone under 250% of the federal poverty level. This is the single most misunderstood rule in the Marketplace.
Deductible
Moderate, and dramatically lower with CSR applied
Out-of-pocket max
Moderate, and much lower with CSR applied
HSA
Sometimes eligible
  • Cost-sharing reductions silently upgrade a silver plan's actuarial value to roughly 73%, 87% or 94% depending on your income band.
  • At 94% actuarial value a silver plan can out-cover a gold plan while costing less per month.
  • CSR attaches ONLY to silver. Buy a bronze or gold plan at the same income and you leave it on the table.
  • The benchmark plan that sets your credit is itself a silver plan, which is why silver is the reference point for everything.
Where this lands in the decision tree

Predictable costs

Gold

About 80% actuarial value

$280a month

Higher monthly, much lower when you use it

Who it suits
Households with known ongoing care: a chronic condition, a planned surgery, a pregnancy, regular specialists.
Deductible
Low
Out-of-pocket max
Low
HSA
Rarely eligible
  • In some rating areas gold prices very close to silver once the credit is applied, because of how the benchmark is set.
  • Worth checking every single year even if you have always bought bronze.
  • Gold deductibles are generally too low to qualify as a high-deductible health plan, so an HSA is usually off the table.
Where this lands in the decision tree

Figures are for a single adult in a Tennessee rating area. An estimate for planning, not a quote. HealthCare.gov sets your real credit.

The quirk nobody explains

Cost-sharing reductions attach to silver only

Below 250% of the federal poverty level, a silver plan is quietly upgraded. The premium does not rise to pay for it. Take the same credit to bronze and you leave the whole thing behind.

Scroll the table sideways to see every column.

Silver cost-sharing reduction levels by income band
Income bandSilver becomesWhat that means for you
Under 150% FPLAbout 94% actuarial valueThe largest reduction. A silver plan at this level typically has a small deductible and low copays, and often beats gold outright.
150% to 200% FPLAbout 87% actuarial valueStill a substantial upgrade. Deductible and out-of-pocket maximum both drop sharply against standard silver.
200% to 250% FPLAbout 73% actuarial valueA modest improvement on standard silver. Worth having, and worth comparing against gold at this level.
Above 250% FPL70% actuarial value, standardNo cost-sharing reduction at all. Silver has no special power here, so compare on total expected cost.

Your own cost-sharing reduction level is set by the Marketplace from your application.

The HSA question

High-deductible plans and the Health Savings Account

01

It is the plan, not the metal

Only a plan that meets the high-deductible health plan definition makes you HSA-eligible. Most bronze plans qualify, some silver plans do, gold almost never does. Check the plan document, not the colour.

02

Two deductions can stack

For self-employed households, the health insurance premium deduction and the HSA deduction are separate. Both reduce modified adjusted gross income, which can also raise your premium tax credit.

03

Medicare ends contributions

Enrolling in any part of Medicare ends HSA contributions, and Part A can be backdated up to six months. If you are approaching 65 with an HSA, plan the stop date before you file for Social Security.

04

The money is yours

Unlike a flexible spending account, HSA balances roll over and follow you when you change plans, change jobs or retire.

We are not tax advisers. Contribution limits, eligibility rules and deduction treatment change, so confirm your own position with a qualified tax professional. An estimate for planning, not a quote. HealthCare.gov sets your real credit.

Questions about choosing a plan

Gold pays a larger share of your care costs, which is not the same as being better for you. Metal level is a cost-sharing split. If you never use care, bronze wins; if you have a surgery scheduled, gold usually wins; under 250% of the federal poverty level, silver usually beats both.

It depends on the specific plan, not the carrier. Two plans from the same company can have different networks. We check the named practice, and we tell you when a plan would cost you your doctor.

We run each one, with the dose and quantity, against the plan's formulary. A drug on tier 4 in one plan can be tier 2 in another, and that difference outweighs most premium differences over a year.

Only with a qualifying high-deductible health plan. Most bronze plans qualify, some silver plans do, gold almost never does. It is a property of the exact plan, so we check the plan document rather than the metal colour.

A restricted plan available to people under 30 or with a hardship or affordability exemption. It covers the same essential health benefits with three pre-deductible primary care visits, but no premium tax credit can be applied to it. If you qualify for any credit, a subsidised plan almost always beats it.

Bring your drug list and we will finish this in ten minutes

The decision tree gets you to a shortlist. Your prescriptions and your doctors decide which one wins.

Our help is free to you. We are paid by the carrier you choose, and the premium is the same whether you use us or enrol on your own.

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