ACA Marketplace healthcare plans come in four metal levels — Platinum, Gold, Silver and Bronze, plus, in some markets, catastrophic health plans available to those under age 30. The health plan you choose during open enrollment is the one you will use all year. This is why it is so important to choose the metal level that works best for you. For some people, this will be the Silver health plan. Understanding the benefits and drawbacks of each health plan level can help you choose well and get the most of your health insurance all year.

What is a silver health insurance plan?

A Silver health plan is the metal level that falls in the middle of the cost and coverage spectrum of the 4 metal tiers.  Unsubsidized Silver premiums are about halfway between the least and most expensive options. Your actual monthly premium for a Silver plan depends on your income, how many people are covered, and which plan you choose. The out-of-pocket expenses for medical care with a Silver health plan are midrange also. In general, your insurer will pay about 70% of the cost of covered care with a Silver health plan. You will be responsible for the remaining 30%, on average.  However, Silver health plans may further reduce your out-of-pocket health care costs through Cost-Sharing Reductions.

Pros and cons of silver health insurance plans

Benefits of silver plans

Silver health insurance plans, typically offered through the Health Insurance Marketplace in the United States, have several benefits and features that make them attractive options for many individuals and families. Here are some of the key benefits and features of silver plans:

• Affordable Premiums: Silver plans often strike a balance between lower-cost bronze plans and higher-cost gold plans, making them a more affordable choice for many consumers.
• Cost-Sharing Reductions (CSR): Eligible individuals and families with lower incomes may qualify for cost-sharing reductions, which can significantly reduce out-of-pocket expenses like deductibles, copayments, and coinsurance.
• Essential Health Benefits: Silver plans, like all plans offered through the Marketplace, cover essential health benefits, including preventive care, emergency services, hospitalization, prescription drugs, and more.
• Network Access: Silver plans are typically available from a variety of insurance providers, giving consumers options to choose from and access to a network of healthcare providers.
• Metal Tier: Silver is one of the metal tiers used to categorize health insurance plans, indicating that they cover, on average, about 70% of the total cost of covered healthcare services. This helps consumers estimate their out-of-pocket expenses.
• Tax Credits: Depending on your income and family size, you may qualify for premium tax credits (subsidies) to lower the monthly premium cost of your silver plan.
• Choice of Providers: Silver plans often allow you to choose from a wide range of doctors, specialists, hospitals, and healthcare facilities within the plan’s network.
• Preventive Care: Silver plans cover preventive services at no additional cost to you, ensuring that you can receive essential preventive care such as vaccinations, screenings, and wellness visits.
• Pediatric Dental and Vision: Pediatric dental and vision coverage is included in silver plans, making them suitable for families with children.
• Out-of-Pocket Maximum: Like all Marketplace plans, silver plans have a maximum limit on the amount you can be required to pay out of pocket in a policy year, providing financial protection in case of major medical expenses.
• No Pre-existing Condition Exclusions: Silver plans, in compliance with the Affordable Care Act (ACA), cannot deny coverage or charge higher premiums based on pre-existing conditions.
• Access to Preventive Care: Silver plans cover preventive services at no additional cost to you, ensuring that you can receive essential preventive care such as vaccinations, screenings, and wellness visits.
• Prescription Drug Coverage: Silver plans typically include prescription drug coverage, helping you manage the cost of necessary medications.

It’s important to note that the specific benefits and features of silver plans can vary depending on the insurance provider and the state in which you reside. When choosing a health insurance plan, it’s advisable to carefully review plan details, compare options, and consider your individual healthcare needs and budget to select the most suitable plan for you and your family.

Potential drawbacks of silver plans

Silver health insurance plans, like all types of insurance, come with certain limitations and considerations that individuals and families should be aware of when selecting a plan. Here are some key limitations and considerations associated with silver plans:

• Higher Premiums Compared to Bronze Plans: While silver plans offer more generous coverage than bronze plans, they typically come with higher monthly premiums. This can be a financial consideration for individuals and families on a tight budget.
• Out-of-Pocket Costs: Although silver plans cover about 70% of the total cost of covered healthcare services on average, you are still responsible for the remaining 30%. This can include deductibles, copayments, and coinsurance, which can add up, especially if you require significant medical care.
• Not the Highest Coverage Level: Silver plans are not the highest coverage tier available in the Health Insurance Marketplace. Gold and platinum plans offer even more comprehensive coverage, but they also come with higher premiums.
• Income Eligibility for Subsidies: To qualify for premium tax credits (subsidies) that can make silver plans more affordable, your income must fall within a certain range. If your income is too high, you may not qualify for these subsidies.
• Cost-Sharing Reductions (CSR) Eligibility: While silver plans are eligible for cost-sharing reductions (CSR), you must meet specific income requirements to benefit from these reductions. Not all silver plan enrollees will qualify for CSR.
• Provider Networks: Silver plans may have restricted networks of healthcare providers, which means you may need to choose doctors and hospitals from within the plan’s network to receive full coverage. It’s essential to verify that your preferred healthcare providers are included in the plan’s network.
• Prescription Drug Formularies: The specific medications covered by a silver plan can vary, and some prescription drugs may not be included on the plan’s formulary. It’s important to check if your medications are covered.
• Limited Coverage for Dental and Vision: While pediatric dental and vision coverage is included in silver plans, adult dental and vision coverage is usually limited or not included. You may need to purchase separate dental and vision insurance.
• Annual Deductibles: Many silver plans have annual deductibles that you must meet before certain benefits kick in. Be sure to understand the deductible amount and how it applies to your plan.
• Plan Variation by State: Health insurance plans are regulated at the state level, so the availability, coverage, and cost of silver plans can vary from one state to another. What’s available in one state may not be the same in another.
• Change in Premiums: Premiums for silver plans, like all insurance plans, can change from year to year. It’s essential to review your plan during the open enrollment period to make sure it still meets your needs and budget.
• Life Changes: If your life circumstances change during the year (e.g., marriage, having a child, or changes in income), you may need to update your coverage, which could impact your costs and benefits.

When considering a silver health insurance plan, it’s crucial to carefully read the plan’s details, review its network, and evaluate your own healthcare needs and budget. It may also be helpful to compare silver plans with other metal tiers (bronze, gold, platinum) to determine which offers the best value for your specific situation.

Silver plan cost structure

Because of the American Rescue Act of 2021, monthly payments for all plans reach record affordability during the 2022 coverage year. If you qualify for a premium tax credit — also known as a premium subsidy — this will reduce your monthly premium cost.

Marketplace subsidies work by capping an individual’s required premium contribution toward a benchmark plan (the second-lowest-cost silver plan) at a certain percent of their income.  As a result of the American Rescue Act and its new financial help with premiums means that 4 out of 5 people may find a plan for $10 or $0 per month.  According to a recent study by the Kaiser Family Foundation, on average, current individual market enrollees who either stay or move onto the Marketplace may be expected to pay $205 per month for a benchmark silver plan, ranging from $0 per month for people with incomes below 150% of poverty to an average of $513 per month for people with incomes over 600% of poverty.

How Cost Sharing Reductions (CSRs) work

Cost sharing reductions are extra savings that are available to people within a certain income range who choose a Silver health plan. Cost sharing reductions work with a Silver health plan in a few different ways:

• A lower deductible. With most health plans, you will have a specific deductible that you must meet each year before your insurance begins paying its portion of the cost (70% on average for Silver plans) for covered services. For instance, you may have a deductible of $1200 per year. However, if you qualify for a cost sharing reduction, your deductible may be reduced to $700, $500 or another number based on your income.
• Lower copays or coinsurance. This means that you may see these per visit fees drop, for instance, from $35 to $15 or $20. This means you pay less each time you visit the doctor on your Silver health plan.
• Lower out of pocket maximums. ACA health insurance plans typically have a maximum out of pocket limit. After that is met, the insurance company absorbs all covered costs. With a Silver health plan and cost sharing reduction, your out of pocket can drop significantly.

Silver plan coverage details

Silver health insurance plans are categorized by metal tiers, and silver plans typically cover about 70% of the total cost of covered healthcare services on average.

Here’s an explanation of what’s covered by silver health plans:

• Essential Health Benefits (EHBs): Silver plans, like all Marketplace plans, are required to cover a set of essential health benefits, which include:
  • Ambulatory patient services: Outpatient care received without being admitted to a hospital.
  • Emergency services: Treatment for sudden, severe medical conditions.
  • Hospitalization: Inpatient care, including surgery and overnight stays.
  • Maternity and newborn care: Prenatal and postnatal care, labor, delivery, and care for newborns.
  • Mental health and substance abuse services: Treatment for mental health conditions and addiction.
  • Prescription drugs: Coverage for necessary medications.
  • Rehabilitative and habilitative services and devices: Therapy and devices to help with physical or developmental conditions.
  • Laboratory services: Diagnostic tests and screenings.
  • Preventive and wellness services: Routine check-ups, immunizations, and screenings.
  • Pediatric services: Including dental and vision care for children.
• Preventive Care: Silver plans cover a range of preventive services at no additional cost to you. This includes vaccinations, cancer screenings, well-woman visits, and other preventive measures aimed at catching and addressing health issues early.
• Doctor Visits: Silver plans typically provide coverage for visits to primary care physicians, specialists, and other healthcare providers. You may have to pay a copayment or coinsurance for these visits.
• Emergency Care: In the case of a medical emergency, silver plans cover emergency room visits, including ambulance services and hospitalization.
• Hospital Care: If you need inpatient hospital care, such as surgery or a stay in the hospital, a silver plan will provide coverage. You will likely be responsible for a portion of the costs, such as deductibles and coinsurance.
• Prescription Drugs: Silver plans include coverage for prescription medications, although the specific drugs covered can vary. You may need to pay copayments or coinsurance for your medications.
• Mental Health and Substance Abuse Treatment: These plans cover mental health services and treatment for substance abuse, including counseling and therapy.
• Rehabilitation Services: If you require physical therapy, occupational therapy, or other rehabilitation services, silver plans offer coverage.
• Maternity and Newborn Care: Silver plans cover prenatal care, labor, delivery, and postnatal care for expectant mothers and newborns.
• Pediatric Dental and Vision: Pediatric dental and vision care are included in silver plans, ensuring that children have access to essential dental and vision services.

It’s important to note that while silver plans cover a substantial portion of healthcare costs, you will still have some out-of-pocket expenses, including deductibles, copayments, and coinsurance. The specific details of coverage, costs, and provider networks can vary by insurance provider and state, so it’s crucial to carefully review the plan documents and compare options during the open enrollment period to choose the plan that best fits your needs and budget.

Silver plans vs. other metal tiers

In general, a Silver health plan covers on average 70% of medical care.  You can see how the metallic plans compare below:

Plan Category	Insurance pays	Insured pays
Bronze	60%	40%
Silver	70%	30%
Gold	80%	20%
Platinum	90%	10%

In this table, we can see a concise breakdown of various health insurance plan categories: Bronze, Silver, Gold, and Platinum. Each category represents different levels of coverage and cost-sharing between the insurance provider and the insured individual.

Starting with Bronze plans, insurance pays for 60% of healthcare costs, while the insured individual is responsible for covering the remaining 40%. Moving up to Silver plans, insurance coverage increases to 70%, with the insured individual’s share reduced to 30%.

Gold plans offer even more comprehensive coverage, with insurance covering 80% of healthcare expenses, leaving the insured responsible for 20%. At the highest level of coverage, Platinum plans, insurance pays a substantial 90% of healthcare costs, leaving only 10% of the expenses to be covered by the insured individual.

As with other metallic plans of the marketplace, Silver plans cover all  10 essential health benefits. Many Silver plans also cover dental and vision care.

Eligibility for silver plan health insurance

Understanding eligibility for silver plan health insurance is crucial for those considering their options on the Health Insurance Marketplace. Silver plans balance monthly premium costs with out-of-pocket expenses better than other categories, making them an appealing choice for a wide range of individuals and families looking for comprehensive coverage.

1. Citizenship or Lawful Presence: To be eligible for silver plans in the Health Insurance Marketplace, you must be a U.S. citizen, U.S. national, or lawfully present immigrant.
2. Residency: You must reside in the state where you’re applying for coverage through the Marketplace.
3. Income: Your income must fall within a certain range to qualify for premium tax credits (subsidies) that can make silver plans more affordable. Eligibility for subsidies is based on your household income relative to the federal poverty level (FPL). Eligibility thresholds may vary by state.
4. Not Eligible for Other Coverage: Generally, you cannot be eligible for other public coverage, such as Medicaid or Medicare, to enroll in a silver plan through the Marketplace.

How to choose the right silver plan

Choosing the right silver health insurance plan to meet your specific needs requires careful consideration of several factors:

1. Evaluate Your Healthcare Needs: Start by assessing your healthcare needs. Consider factors like your expected medical expenses, prescription medications, and any chronic conditions you may have. This will help you determine the level of coverage you require.
2. Compare Premiums: Premiums are the monthly payments you make for your insurance coverage. Balance your budget with the premium costs. While silver plans generally have moderate premiums, it’s essential to find a premium that you can comfortably afford.
3. Cost-Sharing: Look at the cost-sharing features of the plan, including deductibles, copayments, and coinsurance. Consider how much you’re willing and able to pay out of pocket for medical services. Lower deductibles and copayments may mean higher monthly premiums.
4. Network of Providers: Check the plan’s network of healthcare providers, including doctors, hospitals, and specialists. Ensure that your preferred healthcare providers are in-network to avoid higher costs for out-of-network care.
5. Prescription Drug Coverage: If you take prescription medications regularly, review the plan’s prescription drug formulary to ensure that your medications are covered. Consider the copayments or coinsurance for prescription drugs as well.
6. Coverage for Specific Services: Determine if the plan covers specific services you anticipate needing, such as maternity care, mental health services, or preventive care. Ensure that the plan aligns with your healthcare priorities.
7. Additional Benefits: Some silver plans may offer extra benefits like telemedicine services, wellness programs, or dental and vision coverage for adults. Evaluate whether these additional features align with your needs.
8. Out-of-Pocket Maximum: Understand the annual out-of-pocket maximum, which is the most you would have to pay for covered services in a policy year. Consider whether you can manage this potential cost if you face significant medical expenses.
9. Financial Assistance: If you qualify for premium tax credits (subsidies) or cost-sharing reductions (CSRs) based on your income, take advantage of them to make your silver plan more affordable.
10. Customer Service and Support: Consider the quality of customer service and support provided by the insurance company. Read reviews and check the company’s reputation for responsiveness and helpfulness.
11. Plan Ratings: Review plan ratings and rankings, which can provide insights into the overall quality and customer satisfaction of the plan you’re considering.
12. Consult with an Agent or Broker: If you’re uncertain about which silver plan is right for you, consider seeking assistance from a certified insurance agent or broker who can provide personalized guidance based on your unique circumstances.

When making your final choice, it’s essential to carefully read the plan documents, compare options, and consider your individual healthcare needs, budget, and preferences. While websites like eHealth can be useful tools for comparing plans, be sure to gather information from multiple sources to make an informed decision that aligns with your healthcare priorities.

How to enroll in a silver plan

To enroll in silver plans, you’ll need to enroll during the Open Enrollment Period. Here’s an explanation of enrollment for silver plans:

1. Open Enrollment Period: The Open Enrollment Period is the primary opportunity for most individuals and families to enroll in or make changes to their health insurance plans, including silver plans. This period typically occurs once a year, usually in the fall, and lasts for several weeks. During this time, you can apply for a new silver plan, switch plans, or renew your existing coverage.
2. Special Enrollment Periods (SEPs): In certain circumstances, you may qualify for a Special Enrollment Period, allowing you to enroll in a silver plan outside the regular Open Enrollment Period. Qualifying events for SEPs may include getting married, having a baby, losing other health coverage, or experiencing other life-changing events.
3. Medicaid or Children’s Health Insurance Program (CHIP): If you’re eligible for Medicaid or CHIP, you can enroll in those programs at any time, not just during the Open Enrollment Period.
4. Marketplace Website: To enroll in a silver plan, you can visit the Health Insurance Marketplace website for your state or use the federal Marketplace website (HealthCare.gov). These websites provide tools and resources to help you compare available plans and determine your eligibility for subsidies.
5. Assistance: Many individuals and families seek assistance from certified enrollment assisters, insurance agents, or brokers to navigate the enrollment process, especially if they have questions about eligibility or need help with the application.

Enrollment primarily occurs during the Open Enrollment Period, with some exceptions for Special Enrollment Periods. It’s essential to be aware of the specific enrollment timelines and eligibility criteria for silver plans to ensure you can access the coverage that meets your healthcare needs.

FAQs about silver plan health insurance

Who should consider silver health insurance plans?

A Silver health plan is a good choice for many people, because it balances premium and out of pocket medical costs. However, if you are young, do not anticipate using insurance often and have significant amounts of cash in savings, you may find that you save money with a Bronze or catastrophic plan.

A Silver health plan may not be the most cost-effective choice if you expect to receive a lot of medical care for chronic health conditions. A gold plan may be better for you or your family, especially if you are eligible for premium subsidies and cost sharing reductions. That’s because the premium subsidy may make a gold plan’s monthly premium affordable and reduce your out-of-pocket expenses related to deductibles, coinsurance, and copayments.

Use the eHealth private exchange today to learn more about health insurance options that include Silver health plans and more for individuals and families. You may also consult eHealth licensed insurance agents if you have questions. Our services are available 24/7 and at no cost to you.

How do CSRs work if I don’t see a doctor often?

Cost Sharing Reductions (CSRs) are subsidies that reduce out-of-pocket costs for healthcare services, such as deductibles, copayments, and coinsurance. If you don’t visit the doctor often, CSRs might not be directly utilized frequently. However, having CSRs can still be beneficial as they provide financial protection against unexpected medical needs. Even if you are generally healthy and rarely seek medical care, CSRs ensure that if you do need to use healthcare services, your out-of-pocket costs will be significantly reduced, making necessary care more affordable when required.

What if my income changes during the year?

If your income changes during the year, it’s important to update this information in the Health Insurance Marketplace as soon as possible. This adjustment is crucial because it can affect your eligibility for subsidies like premium tax credits and CSRs. If your income increases, you might qualify for less financial aid, and failing to report this could lead to owing money when you file your annual tax returns. Conversely, if your income decreases, you might qualify for more substantial assistance, which could lower your insurance premiums and out-of-pocket costs. Reporting income changes ensures that your health insurance costs are accurately aligned with your current financial situation.