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. Other Metal Plans include Bronze, Gold, and Platinum. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions.HealthCare.Gov, or your state’s Marketplace in states that don’t use HealthCare.Gov, allow you to shop for Silver Plans and apply for cost assistance. Meanwhile, some off-Marketplace providers, agents, or brokers can help enroll you in a Marketplace plan they offer as well. Learn more about options outside the marketplace.
SHOPPING TIP FOR 2018 forward: In past years we had generally suggested a Silver plan with an HSA as a starting point for people looking for “the best health plan.” This was because only silver plans qualify for all of the ACA’s cost assistance options. However, things changed a bit in 2018 due to some insurers raising premiums on Silver plans. When shopping for metal plans today, make sure to check out Bronze, Gold, and even Platinum plans to find out which plan has the best value for you and your family. This year Silver plans are still smart for those who qualify for out-of-pocket cost assistance, but those making 250% or more of the poverty level may find other “metal tier” plans offer better value (especially if they are confident their income won’t drop below 250% of the poverty level). In some cases, a Bronze plan with an HSA will offer the best value despite the high out-of-pocket costs to those who can afford to pay a little more up-front, in other cases a higher metal tier plan will offer attractive cost-sharing despite having higher premiums. Learn more about why non-Silver plans may offer the best value in some cases.
Silver Plans, the Marketplace Standard
Silver Plans are the marketplace standard plan. The second-lowest cost Silver plan in a state is used as the benchmark plan when determining subsidies.
Silver plans provide an average cost sharing value (known as Actuarial Value AV) of 70%. This means that a Silver plan must cover an average of 70% of all that plans enrollees covered out-of-pocket costs (based on a standard population). This does not mean that 70% of actual costs will be covered for anyone given person. In fact, a small minority of policyholders will account for the majority of costs. So actuarial value should always be looked at as a sign of how good a plan’s cost-sharing is, not as a literal amount.
Silver Plans and Subsidies
The biggest perk of Silver Plans is that they can be paired with both Tax Credits and Cost-Sharing Reduction Subsidies. They are the only plan that can pair with Cost Sharing Reduction subsidies. Given this, anyone who qualifies for Cost Sharing Reduction Subsidies (100%-250% of the Federal Poverty Level) will most likely find the best value plan in the Silver metal level.
Not Every Silver Plan is the Same
Depending upon your region and your plan a Silver plan can have a wide range of costs, benefits, and networks. Remember it only has to have an average value of 70%. Insurers can use a number of different cost-sharing arrangements to come to this number.
Also, there is no hard-and-fast rule for what benefits and cost-sharing a plan must offer beyond the minimum requirements. This means a plan can have a narrow network, or only cover certain drugs, or limit the amount of times you can access a service, or provide high cost-sharing in one area and low cost-sharing in another and still be considered a Silver plan. Check out our section on comparing health plans for more information.
Should I Get a Silver Plan?
If you make between 100%-250% of the Federal Poverty Level there is a strong chance that you will want to pick up a Silver plan on the Marketplace. This is the only way to maximize your savings. Since your out-of-pocket costs will be lower (based on income), it’s very hard to go wrong.
You won’t even have to pay back cost-sharing subsidies if your income increases. Read that line over-and-over again, with cost assistance taken into account this is one of the best value plans of any health insurance type. Essentially you’ll get the cost-sharing perks of a higher premium plan at near Medicaid prices.
For those with higher incomes, a Silver plan can still be a smart buy as income can change throughout the year and in this instance, cost-sharing can be adjusted. Also, they are commonly HSA eligible which is a benefit to any taxpayer.
High Deductible Silver Plans and Health Savings Accounts
If you get a high deductible Silver health plan, Consider a Health Savings Account to pay for medical services tax-free. Many Silver plans meet the deductible requirement. A Health Savings Account can even qualify you for more savings / prevent you from owing Tax Credits back if you earn a little more during the year.
FACT: If you have a low income you can use an HSA to reduce MAGI and thus to qualify for more subsidies, this gives you money to spend on care tax-free, and at the same time gives you a better cost-sharing rate and lower premium on your plan. Essentially you’ll know you are going to max out your HSA, so you’ll report a projected income of that much less, thus qualifying for more subsidies, as HSA’s are deducted from your MAGI. Figuring out what that means can save you lots of money, so go ahead and click the in-text links and give it time to sink in.
All Plans Provide Minimum Coverage
All plans must provide minimum benefits, minimum protections, and minimum value. No matter what plan you choose you’ll get a free wellness visit, free preventive care, and won’t be out more than your maximum in an emergency.
Do I Have to Use the Marketplace to Get a Silver Plan?
You can shop inside or outside of the Marketplace for a Silver plan. However, even if you shop outside of the Marketplace you’ll still need to make sure you get a Marketplace Silver Plan offered by your provider. In other words instead of shopping the Marketplace yourself, an off-marketplace broker, agent, or provider can help you shop for a plan, but if you want cost assistance they must enroll you in a Marketplace plan.