Covered California Plans (2024)
Covered California plans are available in tiers: There are four tier levels: Bronze, Silver, Gold and Platinum. The Bronze plan has the highest out of pocket expense, but has the lowest monthly premium. Choosing a higher level plans decreases your out-of-pocket expenses; however, you will be required to pay a higher monthly premium for these plans. Keep in mind, when you need healthcare you will pay much less for these services as you move up to the tiers.
Minimum Coverage
This plan is only available to individuals under the age of 30. There are no out-of-pocket charge for your first three visits each year when you see a doctor or if you need urgent care; it also includes preventative care at no additional cost. However, this is a catastrophic plan. This means that your health insurance is mainly used for worst case situations. You would be required to pay a yearly deductible of $9,450. Once you have met your deductible your plan would pay 100% of your healthcare cost
Bronze Plan
This is the lowest level Plan. You would be required to pay approximately 40% of your medical expenses if you purchase this plan. Some of the benefits for this plan include: Primary Care visit, Urgent Care and Specialist: (limited to 3 visits per year combined.)
- Primary and Urgent Care $60.00 per visit
- Specialist visit $95.00
- Laboratory Tests $40.00
- X-rays and imaging: 40% after deductible is meet
- Individual deductible $6,300
- Family deductible $12,600
Silver Plan
With this plan you will be required to pay approximately 30% of your medical expenses. Some individuals may qualify for an enhanced Silver Plan based on their income. The lower your income the lower your out-of-pocket expense will be.
- Primary and Urgent Care $50.00 per visit
- Specialist visit $90.00
- Laboratory Tests $50.00
- X-rays $95.00
- Imaging $325.00
- Individual deductible $5,400
- Family deductible $10,800
Gold Plan
With this plan you will be required to pay approximately 20% of your medical expenses.
- Primary and Urgent Care $35.00 per visit
- Specialist visit $65.00
- Laboratory Tests $40.00
- X-rays $75.00
- Imaging $75 copay or 25% coinsurance***
- Individual deductible N/A
- Family deductible N/A
Platinum Plan
With this plan you will be required to pay approximately 10% of your medical expenses.
- Primary and Urgent Care $15.00 per visit
- Specialist visit $30.00
- Laboratory Tests $15.00
- X-rays $30.00
- Imaging $75.00 copay or 10% coinsurance***
- Individual deductible N/A
- Family deductible N/A
Enhanced 73, 87, 94
Some individuals may qualify for an enhanced Silver Plan based on their income. The lower your income the lower your out-of-pocket expense will be. The benefit to the enhanced plan is lower out-of-pocket cost to the individual. These plans can pay up to 73%, 87% or as high as 94% of your medical expenses.
Silver 73 Plan
With this plan you will be required to pay approximately 27% of your medical expenses.
- Annual Wellness Exam $0
- Primary and Urgent Care $35.00 per visit
- Specialist visit $85.00
- Emergency Room Facility $350.00
- Laboratory Tests $50.00
- X-rays & Diagnostics $95.00
- Imaging $325.00
- Drugs Tier 1 (Generic Drugs) $15
- Drugs Tier 2 (Preferred Drugs) $55
- Drugs Tier 3 (Non-Preferred Drugs) $85
- Drugs Tier 4 (Specialty Drugs) 20% up to $250 per script***
- Medical Deductible N/A
- Pharmacy Deductible N/A
- Annual Out-of-Pocket Maximun $6,100 (Individual)
- $12,200 (Family)
Silver 87 Plan
With this plan you will be required to pay approximately 13% of your medical expenses.
- Annual Wellness Exam $0
- Primary and Urgent Care $15.00 per visit
- Specialist visit $25.00
- Emergency Room Facility $150.00
- Laboratory Tests $20.00
- X-rays & Diagnostics $40.00
- Imaging $100.00
- Drugs Tier 1 (Generic Drugs) $5
- Drugs Tier 2 (Preferred Drugs) $25
- Drugs Tier 3 (Non-Preferred Drugs) $45
- Drugs Tier 4 (Specialty Drugs) 15% up to $150 per script***
- Medical Deductible N/A
- Pharmacy Deductible N/A
- Annual Out-of-Pocket Maximun $3,000 (Individual)
- $6,000 (Family)
Silver 94 Plan
With this plan you will be required to pay approximately 6% of your medical expenses.
- Annual Wellness Exam $0
- Primary and Urgent Care $5.00 per visit
- Specialist visit $8.00
- Emergency Room Facility $50
- Laboratory Tests $8
- X-rays & Diagnostics $8
- Imaging $50
- Drugs Tier 1 (Generic Drugs) $3
- Drugs Tier 2 (Preferred Drugs) $10
- Drugs Tier 3 (Non-Preferred Drugs) $15
- Drugs Tier 4 (Specialty Drugs) 10% up to $150 per script***
- Medical Deductible N/A
- Pharmacy Deductible N/A
- Annual Out-of-Pocket Maximun $1,150 (Individual)
- $2,300 (Family)
Covered California Plans
Choose Your Plan Type
HMO Plans
HMO stands for Health Maintenance Organization, which is a type of health insurance plan that typically requires you to choose a primary care physician (PCP) who will be your main point of contact for all your healthcare needs.
PPO Plans
PPO stands for Preferred Provider Organization, which is a type of health insurance plan that typically offers a network of healthcare providers that you can use to receive medical care.
EPO Plans
EPO stands for Exclusive Provider Organization, which is a type of health insurance plan that typically offers a network of healthcare providers that you can use to receive medical care.
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