Metal Tier Guide
ACA plans are organized into metal tiers based on how costs are shared between you and the insurance company. Here's what each tier means.
Each metal tier has an actuarial value (AV) — the percentage of average healthcare costs the plan pays. You pay the rest through deductibles, copays, and coinsurance.
Higher metal tier = higher premiums but lower out-of-pocket costs when you use care. Lower metal tier = lower premiums but higher costs when you need healthcare.
Each Tier Explained
Monthly Premium
Lowest
Typical Deductible
Very High (~$9,450)
Plan Pays
~57% of costs
Pros
- Lowest monthly premiums
- Covers 3 free primary care visits
- Free preventive care
Cons
- Very high deductible
- No subsidy eligibility
- Only for under-30 or exempt
Monthly Premium
Low
Typical Deductible
High ($6,000-$8,000)
Plan Pays
60% of costs
Pros
- Low monthly premiums
- Subsidy eligible
- Good for emergencies
- Some HSA-eligible options
Cons
- High out-of-pocket when you use care
- Must meet deductible before most coverage
- Can be expensive if you get sick
Monthly Premium
Moderate
Typical Deductible
Moderate ($2,500-$5,000)
Plan Pays
70% of costs
Pros
- Balanced cost and coverage
- CSR available if income <250% FPL
- Subsidy benchmark plan
- More predictable costs
Cons
- Higher premiums than Bronze
- Still has meaningful deductible
- CSR only at lower incomes
Monthly Premium
Higher
Typical Deductible
Low ($1,000-$2,000)
Plan Pays
80% of costs
Pros
- Lower deductible
- Lower copays
- Better for frequent care
- More coverage before deductible
Cons
- Higher monthly premiums
- May overpay if you stay healthy
- Fewer plan options in some areas
Monthly Premium
Highest
Typical Deductible
Very Low ($0-$500)
Plan Pays
90% of costs
Pros
- Lowest out-of-pocket costs
- Minimal deductible
- Most predictable expenses
- Best for chronic conditions
Cons
- Highest monthly premiums
- Not available in all areas
- May not be worth it if healthy
Quick Decision Guide
- ✓ You're generally healthy
- ✓ You rarely visit the doctor
- ✓ You want lower monthly costs
- ✓ You have savings for emergencies
- ✓ You mainly need coverage for "what ifs"
- ✓ You have ongoing health conditions
- ✓ You take expensive medications
- ✓ You visit doctors frequently
- ✓ You want predictable costs
- ✓ You're planning a major procedure
💡 Pro tip: If your income is below 250% of FPL, consider Silver plans. You may qualify for Cost-Sharing Reductions (CSR) that effectively turn a Silver plan into a Gold or Platinum plan at Silver prices!