Your name is Jack. You are a single 27-year-old non-smoker male, with no children, living in Philadelphia (zip code 19104). You work full-time as a cashier, making $8.65 per hour ($1.40 more than minimum wage). Your annual income is about $18,000, which is equal to 148% of poverty. That means you don’t qualify for Medicaid. However, you do not have access to health insurance through your employer.

Good news! Because your income is less than 400% of poverty, you qualify for an Advanced Premium Tax Credit if you purchase insurance through the Marketplace. You log on to healthcare.gov to look at your options.

There are four levels of health plans: bronze, silver, gold and platinum. These levels are differentiated based on their actuarial value (the average percentage of healthcare expenses that will be paid by the plan). The higher the actuarial value, the more the plan will pay towards your healthcare expenses and, therefore, the lower your out-of-pocket costs will be. Out-of-pocket costs include:

• Deductibles – the amount you owe for covered services before insurance kicks in;
• Copayments – a fixed amount you pay for a covered healthcare service; and
• Coinsurance – your share of the costs of a covered healthcare service.

The downside of plans with higher actuarial values (and lower out-of-pocket costs) is that you have to pay a higher monthly premium. Platinum plans, which have the highest premiums, have 90% actuarial value; gold plans have 80%; silver plans have 70%; and bronze plans have 60% actuarial value. Many different plans exist within each level, with different cost-sharing arrangements (for example, some plans have high deductibles and low coinsurance, and other plans have low deductibles and high coinsurance). In the Marketplace, you compare the many plans that are available. See page 15 for an example of the typical level of benefits provided in the four levels.

Because your monthly income is limited, you decide to consider only bronze and silver plans.

Which plan do you choose?