| Premium Cost | Generally has the lowest monthly premiums among all plan tiers. | Offers moderate monthly premiums, higher than Bronze but lower than Gold and Platinum. | Typically comes with higher monthly premiums compared to Bronze and Silver plans. | Features the highest monthly premiums among all plan tiers. |
| Deductible | Has higher deductibles, meaning individuals must pay more out of pocket before insurance coverage kicks in. | Offers lower deductibles compared to Bronze plans, making it more cost-effective for some. | Usually has even lower deductibles than Silver, providing greater coverage from the start. | Typically has the lowest deductibles among all plan tiers, offering extensive coverage from the outset. |
| Out-of-Pocket Costs | Generally has higher out-of-pocket costs, including copayments and coinsurance for medical services. | Provides moderate out-of-pocket costs, with lower copays and coinsurance than Bronze. | Typically involves lower out-of-pocket costs, making it a balanced choice for many individuals. | Offers the lowest out-of-pocket costs, with minimal copays and coinsurance for covered services. |
| Actuarial Value | Covers about 60% of the average healthcare costs, with the remaining 40% paid by the individual through deductibles and cost-sharing. | Covers about 70% of the average healthcare costs, with the individual responsible for the remaining 30%. | Covers approximately 80% of the average healthcare costs, with individuals paying the remaining 20%. | Covers approximately 90% of the average healthcare costs, with the individual's share limited to about 10%. |
| Coverage Depth | Offers basic coverage and is suitable for individuals who expect minimal healthcare needs or who prefer lower premiums. | Provides moderate coverage, making it a popular choice for those seeking a balance between premiums and coverage. | Offers comprehensive coverage, making it suitable for individuals with frequent healthcare needs or who prioritize extensive coverage. | Provides the highest level of coverage, making it ideal for individuals who want minimal out-of-pocket expenses and extensive benefits. |
| Ideal Candidate | Individuals who are generally healthy, do not expect frequent medical visits, or want to minimize monthly premium costs. | Individuals who anticipate moderate healthcare needs and want a balance between premiums and coverage. | Those with higher healthcare needs, chronic conditions, or who prefer comprehensive coverage. | Individuals who want the most comprehensive coverage available and are willing to pay higher premiums. |
| Preventive Services | All essential preventive services are covered with no cost-sharing, as mandated by the Affordable Care Act (ACA). | All essential preventive services are covered with no cost-sharing, as mandated by the ACA. | All essential preventive services are covered with no cost-sharing, as mandated by the ACA. | All essential preventive services are covered with no cost-sharing, as mandated by the ACA. |
| Specialty Care and Hospitalization | Individuals may have higher copayments and coinsurance for specialist visits and hospital stays. | Copayments and coinsurance for specialist visits and hospitalization are lower than in Bronze plans. | Generally, copayments and coinsurance for specialty care and hospitalization are lower than in Silver plans. | Copayments and coinsurance for specialist care and hospitalization are minimal compared to other tiers. |
| Prescription Drugs | Typically includes prescription drug coverage, with varying levels of cost-sharing for medications. | Prescription drug coverage is included, and cost-sharing for medications is generally moderate. | Includes prescription drug coverage, often with lower cost-sharing for medications compared to Silver plans. | Prescription drug coverage is included with minimal cost-sharing for medications |
