Bronze to Platinum, HMO to HDHP
Picking the right plan can save $200 a month and protect you from a $9,000 deductible. Two dimensions matter: the metal tier (how richly the plan covers costs) and the network type (how you access care).
The four ACA metal tiers
Every ACA-compliant marketplace plan falls into one of four tiers based on actuarial value, the percentage of typical medical costs the plan covers. Bronze covers 60 percent, Silver 70, Gold 80, Platinum 90. The remainder is your share via deductible, copays, and coinsurance.
ACA Metal Tier Ladder
2026 averages| Tier | Premium | Deductible | PCP copay | Coinsurance | OOP max | AV |
|---|---|---|---|---|---|---|
| Bronze | $573 | $7,500 | $45 | 40% | $9,450 | 60% |
| Silver | $752 | $5,000 | $35 | 30% | $8,400 | 70% |
| Gold | $793 | $1,500 | $25 | 20% | $6,500 | 80% |
| Platinum | $1,012 | $500 | $15 | 10% | $3,500 | 90% |
National 2026 averages, KFF and CMS, 40-year-old non-tobacco. Actual amounts vary by carrier and state.
HMO, PPO, EPO, POS, HDHP: how the network works
The metal tier sets your cost share. The network type sets how you access care. Most marketplace plans are HMO or EPO; PPO availability shrank significantly in the 2010s but is rebounding.
| Type | Premium | Referrals | Out of network | Best for |
|---|---|---|---|---|
| HMO | Lower | Yes | Emergency only | Cost-conscious users with a stable PCP relationship |
| PPO | Higher | No | Yes (higher cost) | Frequent specialist users, multi-state travel, brand loyalty |
| EPO | Mid | No | Emergency only | Skip-the-referral users who can stay in network |
| POS | Mid | Sometimes | Yes (higher cost) | Hybrid PPO/HMO flexibility seekers |
| HDHP | Lowest | Varies | Varies | Healthy users maximising HSA tax savings |
HDHP plus HSA: the most tax-efficient pairing
An HDHP must have a 2026 minimum deductible of $1,650 (individual) or $3,300 (family) and an OOP max no higher than $8,300 / $16,600. Pairing with an HSA gives you triple-tax-free saving:
- Contributions are tax-deductible (above the line, no itemising required).
- Growth inside the HSA is tax-free.
- Withdrawals for qualified medical expenses are tax-free at any age.
2026 HSA contribution limits: $4,300 (individual), $8,550 (family), with a $1,000 catch-up after age 55.
Silver plus CSR: the lower-income hidden gem
Cost-sharing reductions are extra benefits stapled onto Silver plans for households below 250 percent FPL. They quietly upgrade Silver into something closer to Gold or Platinum coverage:
- 100 to 150 percent FPL: Silver becomes 94% AV (better than Platinum), deductible drops to ~$300.
- 150 to 200 percent FPL: Silver becomes 87% AV, deductible drops to ~$750.
- 200 to 250 percent FPL: Silver becomes 73% AV, deductible drops to ~$3,000.
CSRs are automatic when you select a Silver plan and report income within range. They are not available on Bronze, Gold, or Platinum tiers.
Decision framework: which plan type is right for you
- 1
How often do you visit the doctor?
Rarely (once or twice a year, no chronic conditions): consider Bronze or HDHP. Often (monthly specialist, multiple prescriptions): Gold or CSR Silver wins.
- 2
Is your income below 250 percent FPL?
Yes: Silver almost certainly beats Bronze because of cost-sharing reductions. No: compare Bronze and Silver on total expected cost.
- 3
Do you have a doctor or specialist you cannot leave?
Yes: filter for plans that include them. PPO if they are out of network of every option. No: HMO usually saves the most.
- 4
Can you save in an HSA?
Yes (you have spare cash flow): HDHP plus HSA is the strongest tax move available. No: pick based on premium and expected use.