Live in California?
Your options will be different, depending on the insurance carrier you choose.
For starters, each insurance carrier in California can elect to offer each coverage level either as an option that offers in- and out-of-network benefits (e.g., a PPO) or an option that offers in-network benefits only (e.g., an HMO).
Also, insurance carriers can choose to offer either the standard Gold option or a Gold II option—not both. The Gold II option offers only in-network benefits.
Review the table below to see which insurance carriers offer out-of-network benefits for the coverage levels you're considering.
Bronze | Bronze Plus | Silver | Gold | Gold II | Platinum | |
---|---|---|---|---|---|---|
Aetna |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
N/A |
In- and out-of-network |
Anthem Blue Cross and Blue Shield |
In-network only |
In-network only |
In-network only |
In-network only |
N/A |
In-network only |
Cigna |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
N/A |
In-network only |
Health Net |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
N/A |
In-network only |
In- and out-of-network |
Kaiser Permanente |
In-network only |
In-network only |
In-network only |
N/A |
In-network only |
In-network only |
United Healthcare |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
In- and out-of-network |
N/A |
In- and out-of-network |
Medical Coverage Level
Bronze | Bronze Plus | Silver | Gold | Gold II | Platinum | |
---|---|---|---|---|---|---|
Option type |
High-deductible option with HSA |
High-deductible option with HSA |
PPO |
PPO |
HMO |
PPO that offers limited benefits for out-of-network care** |
Paycheck contributions |
$ |
$ |
$$ |
$$$ |
$$$ |
$$$$ |
In-network (individual / family) |
$4,900 / $9,800 |
$2,450 / $4,900†◆ |
$1,000 / $2,000 |
$800 / $1,600 |
N / A |
$250 / $500 |
Out-of-network (individual / family) |
$4,900 / $9,800 |
$2,450 / $4,900†◆ |
$2,000 / $4,000 |
$1,600 / $3,200 |
N / A |
$5,000 / $10,000 |
Traditional or true family? |
Traditional |
True family |
Traditional |
Traditional |
N / A |
Traditional |
In-network (individual / family) |
$6,400 / $12,800 |
$3,900 / $7,800‡ |
$5,300 / $10,600 |
$3,600 / $7,200 |
$5,400 / $10,800 |
$2,300 / $4,600 |
Out-of-network (individual / family) |
$12,800 / $25,600 |
$11,500 / $23,000‡ |
$10,600 / $21,200 |
$7,200 / $14,400 |
N / A |
$11,500 / $23,000 |
Traditional or true family? |
Traditional |
True family |
Traditional |
Traditional |
Traditional |
Traditional |
Preventive care |
Covered 100%, no deductible |
Covered 100%, no deductible |
Covered 100%, no deductible |
Covered 100%, no deductible |
Covered 100% |
Covered 100%, no deductible |
Doctor's office visit |
You pay 25% after deductible |
You pay 25% after deductible |
You pay $30 for PCP visit and $50 for specialist visit, no deductible |
You pay $25 for PCP visit and $40 for specialist visit, no deductible |
You pay $25 for PCP visit and $40 for specialist visit |
You pay $25 for PCP visit and $40 for specialist visit, no deductible |
Emergency room |
You pay 25% after deductible |
You pay 25% after deductible |
You pay $150, then 30% after deductible |
You pay $150, then 25% after deductible |
You pay $150, then 30% after copay |
You pay $150, then 15% after deductible |
Urgent care |
You pay 25% after deductible |
You pay 25% after deductible |
You pay $50 |
You pay $40 |
You pay $40 |
You pay $25 |
Inpatient care |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 30% after deductible |
You pay 25% after deductible |
You pay 30% |
If not an office visit, you pay 15% after deductible |
Outpatient care |
You pay 25% after deductible |
You pay 25% after deductible |
If not an office visit, you pay 30% after deductible |
If not an office visit, you pay 25% after deductible |
If not an office visit, you pay 30% |
If not an office visit, you pay 15% after deductible |
Prescription Drug Coverage
Bronze | Bronze Plus | Silver | Gold | Gold II | Platinum | |
---|---|---|---|---|---|---|
Preventive drugs | You pay $0** | You pay $0** | You pay $0** | You pay $0** | You pay $0** | You pay $0** |
Tier 1 (generally lowest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $12 | You pay $10 | You pay $10 | You pay $8 |
Tier 2 (generally medium cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $50 | You pay $40 | You pay $40 | You pay $30 |
Tier 3 (generally highest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $70 | You pay $60 | You pay $60 | You pay $50 |
Tier 1 (generally lowest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $30 | You pay $25 | You pay $25 | You pay $20 |
Tier 2 (generally medium cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $125 | You pay $100 | You pay $100 | You pay $75 |
Tier 3 (generally highest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $175 | You pay $150 | You pay $150 | You pay $125 |
Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier.
Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You may need to designate a primary care physician to coordinate your care if you choose Kaiser Permanente or Health Net as your insurance carrier.
Do You Take Any Prescription Drugs?
Your prescription drug coverage will be provided through your insurance carrier’s pharmacy benefit manager.
While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how your family's medications will be covered. Get the details.
Questions?
Check out the Frequently Asked Questions (PDF) and the Glossary.