Last reviewed: 6 October 2026

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Bronze, silver, gold and platinum health plans: what the federal definitions and HealthCare.gov say the tiers mean

The short answer: the ACA statute defines four levels of coverage by actuarial value, meaning the share of the full cost of covered benefits that a plan is designed to pay for a standard population: 60 percent for bronze, 70 for silver, 80 for gold and 90 for platinum.^[1] HealthCare.gov says the categories have nothing to do with the quality of care you get, and that every Marketplace plan in every category must cover the same 10 essential health benefits.^[2] This page explains the definitions. It does not say which tier to pick.

The short version

• Level is set by actuarial value (AV), calculated for a standard population, "without regard to the population the plan may actually provide benefits to."^[1]
• The HealthCare.gov figures are estimates of the plan's share and your share of costs for covered services, and it says the actual costs you pay vary by plan.^[2]
• The statute limits the cost sharing incurred under a health plan in a plan year; premiums, balance billing amounts for non-network providers and spending on non-covered services are not counted as cost sharing.^[1]

The four levels side by side

The statute's percentages and HealthCare.gov's "plan pays / you pay" table line up for the four metal levels. The "deductible is generally" column is HealthCare.gov's description, not a legal rule.

How a plan gets placed in a tier

• The statute says a plan in each level is "designed to provide benefits that are actuarially equivalent to" 60, 70, 80 or 90 percent of the full actuarial value of the benefits provided under the plan.^[1]
• The federal regulation says AV, calculated as set out in 45 CFR 156.135 and within a de minimis variation, determines whether a plan is bronze, silver, gold or platinum.^[3]
• To calculate AV, an issuer must use the AV Calculator that HHS makes available for the benefit year. A plan whose design does not fit the calculator must use an actuarial certification from a member of the American Academy of Actuaries.^[4]
• The allowable variation is minus 4 and plus 2 percentage points. For a bronze plan that either covers and pays for at least one major service other than preventive services before the deductible, or is a high deductible health plan within the meaning of section 223(c)(2) of the Internal Revenue Code, it is minus 4 and plus 5 percentage points.^[3]

What every tier has in common

• HealthCare.gov says all Marketplace plans in every category must cover the same 10 essential health benefits, including preventive services.^[2]
• The statute's list of essential health benefit categories is: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care.^[1]
• The statute says the cost sharing incurred under a health plan may not exceed a dollar limit for the plan year. The limit starts from the amounts in effect under the Internal Revenue Code's section 223(c)(2)(A)(ii) for 2014 and is increased for later years by a premium adjustment percentage. It defines cost sharing to include deductibles, coinsurance, copayments and similar charges, and any other required expenditure that is a qualified medical expense for covered essential health benefits, and to exclude premiums, balance billing amounts for non-network providers and spending for non-covered services.^[1]

What the tier name does not tell you

• Quality: HealthCare.gov says the name of a plan category "has nothing to do with its quality of care," and points to a separate 1-5 star quality rating.^[2]
• Your own bill: the AV is computed for a standard population, not for your health needs or the way you use care.^[1] HealthCare.gov says the percentages are estimates and the actual costs vary by plan.^[2]
• The premium: the tiers describe how costs are shared when you get care. HealthCare.gov separately lists the premium as a monthly amount you pay whether or not you get services.^[2]

Three other things HealthCare.gov ties to categories

• Extra savings (cost-sharing reductions): HealthCare.gov says you only get these if you enroll in a Silver plan; they lower what you pay for deductibles, copayments and coinsurance.^[2]
• Premium tax credit: it says if you qualify you can get lower premium costs in any metal plan category.^[2]
• Health Savings Accounts: it says all Bronze and Catastrophic plans work with an HSA, and some plans in other categories do.^[2]

Catastrophic plans: a fifth category, with its own rules

• The statute treats a plan that is not bronze, silver, gold or platinum as meeting the level requirement if only certain individuals can enroll: people who have not reached 30 before the plan year starts, or who have a certification of an exemption based on affordability or hardship.^[1]
• Such a plan must provide the essential health benefits except that it pays no benefits until the individual has incurred cost sharing equal to the annual limit, except as provided for in section 2713 (which the Code's editorial note says probably means 42 U.S.C. 300gg-13), and it must cover at least three primary care visits; it may be offered only in the individual market.^[1]
• HealthCare.gov says Catastrophic plans are a fifth category available, if offered in your area, to people under 30 or who qualify for a hardship or affordability exemption.^[2]

How to verify this yourself

Read 42 U.S.C. 18022(d) for the four definitions and 45 CFR 156.140 for the allowable variation, then HealthCare.gov's plan categories page. When you view real plans, open each plan's Summary of Benefits and Coverage; it states the deductible and cost-sharing lines for that plan, which the tier percentages do not.

What this page does not cover

We do not say which tier suits any person or budget, rank any plan, or compare premiums. We do not cover how extra-savings eligibility is determined, tax credit amounts, how HHS sets the annual cost-sharing cap, state-specific plan standardization, or employer plans outside the Marketplace. Rules and amounts change each plan year. This is general information, not insurance or legal advice. For your own situation, ask your agent or insurer, or contact your state insurance regulator.

Your next step

When you compare real plans, read each plan's Summary of Benefits and Coverage rather than relying on the tier name. Our guide to the Summary of Benefits and Coverage lists what the federal rule requires it to show.

Related checks

Our standard explains how we check an agent's license and disciplinary history. Check an agent reports our findings at category level, as a method and not a verdict. Neither reviews any insurer, plan or product. For the cost-sharing terms in plain words, see deductible, copay, coinsurance and out-of-pocket maximum. For when you can enroll, see ACA enrollment periods. For who helps you enroll, see Navigator, CAC or agent. More plain-language guides are in the agent guides.

When we will update this page

We re-read the sources when they change. If something here is out of date, tell us. Corrections are dated on the page.

References

1. [1] Cornell Law School Legal Information Institute, text of 42 U.S.C. § 18022 (essential health benefits requirements), subsections (b) to (e), read 6 October 2026 — law.cornell.edu/uscode/text/42/18022
2. [2] HealthCare.gov, "Health plan categories: Bronze, Silver, Gold & Platinum", read 6 October 2026 — healthcare.gov/choose-a-plan/plans-categories
3. [3] Electronic Code of Federal Regulations, 45 CFR § 156.140 (levels of coverage), read 6 October 2026 — ecfr.gov/current/title-45/section-156.140
4. [4] Electronic Code of Federal Regulations, 45 CFR § 156.135 (AV calculation for determining level of coverage), read 6 October 2026 — ecfr.gov/current/title-45/section-156.135