ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.
Based on an average person’s expected use of healthcare services, Silver Plans have the insurance company pay 70% of covered healthcare expenses. The remaining 30% of expenses are paid out-of-pocket by the policyholders. These out-of-pocket expenses include deductibles, copayments, and coinsurance. However, the plan’s monthly premium is not included as one of these out-of-pocket costs.
|Cost-Sharing Category||Average for a Silver Plan|
|Deductible for an individual enrollee||$4,110|
|Deductible for a family||$8,413|
|Preferred brand drugs||$60|
|Non-preferred brand drugs||$118|
|Specialty drugs||42% of specialty drug expense charged to patient as coinsurance fee|
|Annual cap on out-of-pocket costs for an individual||$7,716|
|Annual cap on out-of-pocket costs for a family||$15,064|
Even though both Silver Plan examples cover 70% of medical costs, this coverage applies to a typical enrollee population. Some individuals may receive more cost sharing and some less depending on the medical services used. The out-of-pocket costs also assume enrollees are using doctors and facilities approved by the plan. If you use a healthcare provider who is not approved, you could pay considerably higher costs, and those costs might not apply towards the maximum out-of-pocket expenses you can pay in a calendar year.
There are also special versions of Silver Plans with lower out-of-pocket costs for people whose income qualifies them for enrollment. These Silver Plans are known as Cost-Sharing Reduction" plans or CSR plans.
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.
The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.
A deductible is the amount a consumer pays for covered medical services. HealthPocket found individual Silver plan medical deductibles were $4,110 on average in the individual and family market.
A state insurance exchange uses the premium amount from a selected Silver Plan within the state to serve as the basis for subsidy calculations. The Silver Plan selected is the Silver Plan in the exchange with the second lowest premium. Even if a subsidy-eligible person chooses a Bronze, Gold, or Platinum plan, his or her subsidy amount is calculated based on the benchmark Silver Plan.
Silver Plans have the same benefit requirements as Bronze Plans. These benefit requirements are known as the Essential Health Benefits. An insurance company can choose to add benefits to a Silver Plan as well as any of the other new Affordable Care Act health plans. However, adding benefits is not required and does not distinguish a Silver Plan from a Bronze Plan, Gold Plan, or Platinum Plan.
The answer is tricky. On average, Silver Plans should have higher premiums than Bronze Plans since Silver Plans pay a higher percentage of medical costs. However, prices vary among insurers and prices vary among regions so it is theoretically possible that there can be a specific Silver Plan that is less expensive than a specific Bronze Plan, but this is expected to be an exception rather than the rule.
No. CSR health plans are Silver Plans and enrollees must meet income eligibility criteria. To learn more, visit our Cost-Sharing Reduction (CSR) Health Insurance Page.
On exchanges, every participating insurer offering products must include at least one Silver Plan and one Gold Plan. The same rules do not apply to carriers offering products outside of government exchanges.
No. You may apply your subsidy amount to any of the metal plans purchased on a state health insurance exchange. However, the premium subsidy amount is based on the benchmark Silver Plan.
The Affordable Care Act provides federal tax credits to people with middle incomes and low incomes whether they are buying individual or family insurance plans. The tax credit is based on the Silver Plan’s costs. If you are wondering what the tax credit is and how to determine if you are eligible then visit our Affordable Care Act Tax Credit page.
Silver plans have the second lowest premium rates of the four new types of metal plans since they charge the second highest out-of-pocket costs. However, there may be instances where the Silver Plan of one insurance company may charge a lower premium than the Bronze Plan of another insurance company, as well as instances where the Gold or Platinum Plan of one insurance company may charge a lower premium than the Silver Plan of another insurance company. HealthPocket’s health insurance comparison tool allows people to compare all the plans available in their area.
Below are the average monthly premiums found for 2018, 2019, and 2020 Silver plans across states using the Healthcare.gov marketplace.
All metal plans including silver plans can be obtained on- or off-exchange. On-exchange refers to either the Federally-facilitated marketplace or a state-based marketplace, and off-exchange refers to a private insurance company. All metal plans, whether sold on- or off-exchange, must meet the Affordable Care Act’s essential health benefit requirements. Typically the benefits and cost-sharing for the same silver plan (plan with same name for the same individual and rating area) purchased on- or off-exchange are the same. Premiums for the same silver plan offered by the same insurer on- or off-exchange are also generally similar, if not the same.