• Connect with health insurance carriers.
  • Your Carrier Connection. LEARN MORE

California Medical Coverage Level

Live in California?

Your options will be different, depending on the insurance carrier you choose.

For starters, each insurance carrier in California has the option 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
Aetna

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

Independence Blue Cross

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

Cigna

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In-network only

Health Net

Northern California
In-network only
Southern California
In- and out-of-network

Northern California
In-network only
Southern California
In- and out-of-network

Northern California
In-network only
Southern California
In- and out-of-network

N/A

In-network only

Kaiser Permanente

In-network only

In-network only

In-network only

N/A

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


Medical Coverage Level

Bronze Bronze Plus Silver Gold Gold II
Option type

High-deductible option with HSA

High-deductible option with HSA

PPO

PPO

HMO

Paycheck contributions

$

$

$$

$$$

$$$

Annual Deductible
In-network (individual / family)

$3,300 / $6,600

$2,450 / $4,900

$1,000 / $2,000

$800 / $1,600

N / A

Out-of-network (individual / family)

$3,300 / $6,600

$2,450 / $4,900

$2,000 / $4,000

$1,600 / $3,200

N / A

Traditional or true family?

Traditional

True family

Traditional

Traditional

N / A

Annual Out-of-Pocket Maximum
In-network (individual / family)

$6,400 / $12,800

$3,900 / $7,800

$5,300 / $10,600

$3,600 / $7,200

$5,400 / $10,800

Out-of-network (individual / family)

$12,800 / $25,600

$11,500 / $23,000

$10,600 / $21,200

$7,200 / $14,400

N / A

Traditional or true family?

Traditional

True family

Traditional

Traditional

Traditional

In-Network Benefits
Preventive care

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%

Doctor's office visit

You pay 25% after deductible

You pay 25% after deductible

You pay 30% after 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

Emergency room

You pay 25% after deductible

You pay 25% after deductible

You pay $150, then 30% after deductible

You pay 25% after deductible

You pay 30%

Urgent care

You pay 25% after deductible

You pay 25% after deductible

You pay 30% after deductible

You pay 25% after deductible

You pay 30%

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%

Outpatient care

You pay 25% after deductible

You pay 25% after deductible

You pay 30% after deductible

If not an office visit, you pay 25% after deductible

If not an office visit, you pay 30%


Prescription Drug Coverage

Bronze Bronze Plus Silver Gold Gold II
Preventive drugs You pay $0** You pay $0** You pay $0** You pay $0** You pay $0**
30-Day Retail Supply
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
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
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
90-Day Mail Order Supply
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
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
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


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?

This is really important! 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 the insurance carrier will cover any medications you and your covered family members need. Get the details.


Questions?

It’s easy to find answers! Check out the Frequently Asked Questions (PDF) and the Glossary.


Make It Yours To Go