Bronze Health Insurance Plans

A bronze health plan is a type of individual/family or small group health insurance that pays, on average, 60% of average enrollees' healthcare expenses. The enrollees pay the other 40% of their total healthcare expenses in the form of copayments, coinsurance, and deductibles.

But this 60/40 split is an average across a standard population—the percentage of your costs that a plan covers will vary tremendously depending on whether you need a lot of medical care during the year, or not much at all.

This article will explain how bronze plans work, how they're regulated, where they can be obtained, and how you can determine whether a bronze plan might be a good fit for your needs and budget.

The determination of whether a plan fits into the bronze level of coverage is based on actuarial value. Bronze plans are available in both the individual and small group health insurance markets, in the exchange or outside the exchange (ie, directly through health insurance companies).

How to Compare Plans

To make it easy to compare how much value you’re getting for the money you spend on health insurance premiums, the Affordable Care Act standardized value levels for individual and small group health plans into four tiers. These tiers are bronze, silver, gold, and platinum.

All of the health plans of a given tier offer roughly the same overall value, although they can fluctuate within a +2/-2 range. The allowable range has fluctuated over the years; it was +2/-2 from 2014 through 2018, then +2/-4 from 2018 through 2022, and reverted to +2/-2 as of 2023, with stricter rules for silver-level plans sold in the individual market.

And since 2018, bronze plans have had a wider de minimus range due to the introduction of expanded bronze plans that have enhanced benefits and actuarial value as high as 65%. Through 2022, the allowable range was +5/-4, but that has been tightened to +5/-2 as of 2023.

For bronze-tier plans, the average actuarial value is roughly 60%. But with the allowable de minimus range, plans with actuarial values of 58% to 65% are considered bronze plans. So although the ACA's metal level designations do help in terms of making it easier to make general comparisons among plans, it's still important to look at the fine print, as two bronze plans can have quite different benefit designs and coverage levels.

What Value Means

Value, or actuarial value, tells you what percentage of covered healthcare expenses a plan would be expected to cover for an entire standard population. This doesn’t mean that you, personally, will have exactly 60% of your healthcare costs paid by your bronze plan. Depending on how you use your health insurance, you might have a lot more or less than 60% of your expenses paid.

A person with very high healthcare costs will obviously pay far less than 40% of the total costs because the plan's out-of-pocket maximum will limit the amount the member pays. On the other hand, a person with very low overall expenses can expect to pay far more than 40% of the total costs, since he or she might not even meet the deductible for the year, and thus might be paying virtually all of their own medical expenses.

Non-covered healthcare expenses aren’t taken into account when determining a health plan’s value. Out-of-network costs also are not counted, and neither are costs for treatment that doesn't fall into the ACA's essential health benefits categories.

What You Will Have to Pay

You’ll have to pay monthly premiums for the health plan. You’ll also have to pay cost-sharing like deductibles, coinsurance, and copays when you use your health insurance. Bronze plan monthly premiums tend to be cheaper than higher-value plans because bronze plans expect to pay less money toward your healthcare bills.

If you buy your coverage in the health insurance exchange in your state and you're eligible for premium subsidies, you might find that you can get a bronze plan for free after your subsidy is applied.

This is due to the way insurers have added the cost of cost-sharing reductions to silver plan premiums in most states. Since subsidy amounts are based on the cost of the second-lowest-cost silver plan, the higher premiums for silver plans result in larger premium subsidies.

Since those subsidies can also be applied to bronze or gold plans, they're sometimes large enough to cover the entire premium, leaving the enrollee with no monthly premium. This is true in many cases for bronze plans, and is even true in some cases for gold plans; don't assume that bronze plans are your only option for free or low-cost coverage.

The availability of very low-cost plans has grown in recent years as a result of the American Rescue Plan, which has made subsidies larger and more widely available. The subsidy enhancements were initially set to expire at the end of 2022, but the Inflation Reduction Act has extended them through 2025, ensuring that coverage continues to be more affordable for most exchange/marketplace enrollees than it was prior to 2021.

When it comes to cost-sharing, the way that each plan makes you pay your share of your healthcare expenses will vary. For example, one bronze plan might have a fairly high $8,000 deductible paired with a low 10% coinsurance. A competing bronze plan might have a lower $6,000 deductible paired with a higher 35% coinsurance and a $45 copay for office visits.

Regardless of how the plan is structured, all ACA-compliant health plans have upper limits on total out-of-pocket costs that apply regardless of the metal level; no plans can have individual out-of-pocket limits—including deductible, copay, and coinsurance—in excess of $9,100 for a single individual in 2023.

Reasons to Choose a Bronze Plan

In choosing a health plan, if the most important factor to you is a low monthly premium, a bronze-tier health plan can be a good choice. If you don’t expect to use your health insurance much or if the high cost-sharing inherent in a bronze plan doesn’t concern you, a bronze health plan might fit the bill.

And a bronze plan might also be the best choice if you know that you'll meet the out-of-pocket limit no matter which plan you select (ie, you know you'll have extensive medical costs during the year). If the total cost of the premiums plus the out-of-pocket exposure is lower than it would be for other available plans, a bronze option might be best even if you anticipate significant medical claims.

If you're under 30 (or 30+ with a hardship exemption from the ACA's individual mandate) and aren't eligible for premium subsidies, you might find that a catastrophic plan offers an even lower monthly premium, along with a slightly lower actuarial value.

(Catastrophic plans don't have actuarial value targets the way metal level plans do; they must simply have actuarial values under 60%, although they must also cover three primary care visits per year and adhere to the same upper limits on out-of-pocket costs as other plans.)

If you’re 30 or older, though, you won’t be able to buy a catastrophic plan unless you have a hardship exemption from the ACA's individual mandate. And premium subsidies can't be applied to catastrophic plans, which makes them a poor choice for most people who are eligible for premium subsidies.

Most enrollees are eligible for subsidies, and that's especially true as a result of the American Rescue Plan. So in most cases, this makes subsidized bronze plans a better choice than catastrophic plans, since the catastrophic plans are always unsubsidized.

Reasons Not to Choose a Bronze Plan

Don’t choose a bronze-tier health plan if you want a plan that pays for most of your healthcare expenses. If you expect to use your health insurance a lot, or you can’t afford high copays, coinsurance, and deductibles, a bronze plan might not be for you.

Don't assume, however, that a bronze plan is a bad choice if you know you're going to need extensive medical care. In some cases, the total expenses (out-of-pocket costs plus premiums) end up being lower with a bronze plan, even when the enrollee has to meet the full out-of-pocket maximum for the year. You'll want to run the numbers before you make a decision.

If you’re eligible for cost-sharing subsidies because your income is 250% of federal poverty level or lower, you can only get the cost-sharing subsidies if you choose a silver-tier plan. You won’t get the cost-sharing subsidies you qualify for if you choose a bronze plan.

Cost-sharing subsidies make your deductible, copays, and coinsurance lower so you pay less when you use your health insurance. In effect, a cost-sharing subsidy will increase the value of your health plan without raising the monthly premiums. It’s like getting a free upgrade on value. You won’t get the free upgrade if you choose a bronze plan.

Summary

Bronze health plans are sold in the individual and small group health insurance markets. They comply with all of the ACA's requirements, and are designed to cover roughly 60% of medical costs across a standard population (with wide variation in terms of the percentage of any particular member's costs that are covered).

Bronze plans tend to have lower premiums than the other metal levels (silver, gold, and platinum), but also higher out-of-pocket costs. The maximum allowable out-of-pocket exposure is $9,100 for a single person in 2023, regardless of metal level. Bronze plans often have out-of-pocket caps that are at or nearly at the allowable maximum.

A Word From Verywell

If you're shopping for your own health coverage in the exchange/marketplace, the default display is likely to show you plans based on premium cost, from lowest to highest. So you'll generally see bronze plans first, and you might have to scroll through quite a few bronze plans before you see plans at the higher metal levels. But it's important to keep scrolling, and to consider all of the available options.

You can also use the exchange's filters to go directly to certain plans. For example, if you're eligible for cost-sharing reductions, you'll want to carefully consider all of the available silver plans before settling on a choice.