The Different Types of Health Insurance Plans

You have options when choosing a health plan, whether you’re an individual looking for insurance for yourself and your family or the owner of a small business. You may choose the health insurance plan that best suits your coverage needs and financial situation by being aware of the various types of health insurance plans that are available to you. The Different Types of Health Insurance Plans

Major medical health plans and the metallic categories


The health insurance policies available are categorised into four metals: Bronze, Silver, Gold, and Platinum if you purchase it through a private exchange, a public marketplace, or a brokerage company like eHealth.

These plans all adhere to the Affordable Care Act (often known as Obamacare), cover the 10 essential health benefit categories, and have a maximum out-of-pocket expense cap. In 2022, individuals with individual health insurance plans will only be required to pay up to $8,700 towards their medical expenses, with a cap of $17,400 in place for coverage of multiple people.

Beyond that shared feature, each plan differs from one another in terms of premium and charge-sharing, even when numerous plans are provided by the same insurer. The premium is the cost of your health insurance, which you normally pay on a monthly basis. Cost-sharing describes the split between the insurer’s payment for qualifying medical bills and your out-of-pocket costs. Deductibles, copayments, coinsurance, and the full cost of medical treatments that are not covered by the plan may all be considered out-of-pocket expenses.

The average value of the various health insurance plans, or what percentage of anticipated medical costs the plan will pay over an entire population enrolled in the plan, is indicated on the metallic labels of major medical policies.

  • A Bronze plan will pay about 60% of the bills, and you will contribute about 40%.
  • A Silver plan will pay approximately 70% of the costs; you will contribute approximately 30%.
  • With a Gold plan, you will only be responsible for about 20% of the costs.
  • A Platinum plan will cover around 90% of expenses; your contribution will be 10%.

Generally speaking, a plan’s premium increases with the amount of coverage it offers. Consider the average national premium for metallic health insurance (for a 40-year-old) in 2022 provided by the Kaiser Family Foundation to demonstrate how this theory applies to the metal levels:

Metallic Types of Health InsuranceAverage Premium Cost
Lowest Cost Bronze Plan$329 per month
Lowest Cost Silver Plan$428 per month
Benchmark (2rd lowest cost) Silver Plan$438 per month
Lowest Cost Gold Plan$462 per month
Lowest Cost Platinum Plan$709 per month

You can improve the basic information you have to choose the plan that best suits your needs by understanding how the level of coverage relates to premium and out-of-pocket expenses. The real cost of your premiums will depend on your age, region, the number of individuals covered by your policy, the insurer you choose, and if you are eligible for Affordable Care Act (ACA) subsidies to lower your costs.

Managed care includes health insurance plans such as HMOs, EPOs, POSs, and PPOs.

Benefits for the majority of large medical plans are created to be linked to the utilisation of participating healthcare providers. Understanding the distinctions between a Preferred Provider Organisation (PPO), Exclusive Provider Organisation (EPO), Point of Service (POS) plan, and Health Maintenance Organisation (HMO) is therefore a good idea.

Plans from health maintenance organisations (HMOs)

One of the most common types of health insurance available is an HMO. With this plan, a wide range of healthcare suppliers consent to give you with their services. You must choose a primary care physician (PCP) who manages all of your medical needs.

The majority of preventative care, including specialist visits, is typically covered by HMOs; however, specialist appointments are only reimbursed when your PCP provides a referral. Additionally, you might have a yearly deductible in addition to paying copayments for each non-preventive medical visit. HMOs are typically best suited for people and families that intend to regularly schedule checkups and other medical appointments with their primary care physician. The acceptance of HMO plans has dramatically grown since 2014.

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