You have choices when you shop for health insurance. If you're buying from your state's Marketplace, the federal 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 or qualify for a hardship or affordability exemption, 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 plan carrying the highest deductible. No matter what level of plan you choose, your out-of-pocket expenses will be capped. For most plans, the cap will be $12,000 for an individual or $24,000 for a family in 2027, although plans may have lower out-of-pocket maximums. Also, beginning in 2027, some bronze plans can have an out-of-pocket maximum of $15,600 for an individual or $31,200 for a family. 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%. You may also be eligible for cost-sharing reductions, depending on your income, which lowers your share of the cost further. Cost-sharing reductions are only available on silver plans.
- Bronze: covers 60% on average of your medical costs; you pay 40%
- Catastrophic: Catastrophic policies pay after you have reached a very high deductible ($10,600 in 2026). 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.
You will also see insurance brands associated with the care levels. Some large national brands include Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.
Each insurance brand may offer one or more of these five common types of plans:
- Health maintenance organizations (HMOs)
- Preferred provider organizations (PPOs)
- Exclusive provider organizations (EPOs)
- Point-of-service (POS) plans
- High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)
Take a minute to learn how these plans differ. Being familiar with the plan types can help you pick one to fit your budget and meet your health care needs. To learn the specifics about a brand's particular health plan, look at its summary of benefits.
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. Since the No Surprises Act was passed, out-of-network providers like anesthesiologists and radiologists are limited to in-network rates as well.
What you pay:
- Premium: This is the cost you pay each month for insurance.
- Deductible: Your plan may require you to pay the amount before it covers care, except for preventive care.
- Copays and/or co-insurance for each type of care. A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percentage of the charges for care, for example, 20%. These charges vary according to your plan, and they are counted toward your out-of-pocket
Paperwork involved. There are no claim forms to fill out.
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.
What you pay:
- Premium: This is the cost you pay each month for insurance.
- Deductible: Some PPOs may have a deductible. You may have a separate, higher deductible if you see an out-of-network doctor.
- Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percentage of the charges for care, for example, 20%.
- Other costs: If your out-of-network doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share unless it is for emergency care.
Paperwork involved. There's little to no paperwork with a PPO if you see an in-network doctor. If you use an out-of-network provider, you'll have to pay the provider. Then you have to file a claim to get the PPO plan to pay you back.
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 usually 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.
- Premium: This is the cost you pay each month for insurance.
- Deductible: Some EPOs may have a deductible.
- Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percentage of the charges for care, for example, 20%.
- Other costs: If you see an out-of-network provider, you will have to pay the full bill, unless it is for emergency care.
Paperwork involved. There's little to no paperwork with an EPO.
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, unless it is for emergency care.
What you pay:
- Premium: This is the cost you pay each month for insurance.
- Deductible: Your plan may require you to pay the amount of a deductible before it covers care beyond preventive services. You may pay a higher deductible if you see an out-of-network provider.
- Copays or coinsurance: You will pay either a copay, such as $15, when you get care or coinsurance, which is a percent of the charges for care. Copayments and coinsurance are higher when you use an out-of-network doctor.
Paperwork involved. If you go out-of-network, you have to pay your medical bill. Then you submit a claim to your POS plan to be reimbursed.
Catastrophic Plan
If you are under the age of 30, or qualify for a hardship or affordability exemption, you can purchase a catastrophic health plan. The definition of hardship exemption has expanded to include anyone who is ineligible for premium tax credits or cost-sharing reductions because their income is below 100% of the federal poverty level or above 250%. Premium tax credits cannot be used with catastrophic plans. Starting in 2027, insurers can offer multi-year catastrophic plans for up to 10 consecutive years.
- 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.
What you pay:
- Premium: This is the cost you pay each month for insurance.
- Deductible: A catastrophic health plan has a deductible of $12,000 for an individual and $24,000 for a family in 2027. After you reach that deductible, the plan will pay 100% of your medical costs for covered benefits.
Paperwork involved. You will want to keep track of your medical expenses to show you have met the deductible.
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. If you use the money in your HSA for non-medical expenses, you will have to pay taxes on the withdrawal, along with an additional 20% tax.
- Since 2026, all bronze and catastrophic plans are considered HSA-eligible, even if they don’t meet the usual deductible rules.
What doctors you can see. This varies depending on the type of plan -- HMO, POS, EPO, or PPO
What you pay:
- Premium: An HDHP generally has a lower premium compared to other plans.
- Deductible: The deductible is at least $1,750 for an individual or $3,500 for a family. Like with all plans, your preventive care is usually free even if you haven't met the deductible.
- Out-of-pocket maximum: Not more than $8,700 for an individual and $17,400 for a family in 2027.
- Copays or coinsurance: Other than preventive care, you must pay all your costs up to your deductible when you go for medical care. You can use money in your HSA to pay these costs.
You can set up a Health Savings Account to help pay for your costs. The maximum you can contribute to an HSA in 2027 is $4,500 for individuals and $9,000 for families. You can contribute an additional $1,000 if you are 55 or older.
Paperwork involved. Keep all your receipts so you can withdraw money from your HSA and know when you've met your deductible.
