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 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 Plus Silver Gold Gold II Platinum
Aetna

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network

Anthem

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

N/A

In-network only

Health Net

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

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

N/A

In- and out-of-network


Medical Coverage Level

Bronze Plus Silver Gold Gold II Platinum
Option type

PPO

High-deductible option with HSA

PPO

HMO

PPO that offers limited benefits for out-of-network care**

Paycheck contributions

$$

$$

$$$

$$$

$$$$

2024 Annual Deductible
In-network (individual / family)

$2,300 / $4,600

$1,600 / $3,200

$800 / $1,600

N / A

$250 / $500

Out-of-network (individual / family)

$4,600 / $9,200

$1,600 / $3,200

$1,600 / $3,200

N / A

$5,000 / $10,000

Traditional or true family?

Traditional

True family

Traditional

N / A

Traditional

2024 Annual Out-of-Pocket Maximum
In-network (individual / family)

$6,700 / $13,400

$3,800 / $7,600

$3,600 / $7,200

$5,400 / $10,800

$2,300 / $4,600

Out-of-network (individual / family)

$13,400 / $26,800

$8,000 / $16,000

$7,200 / $14,400

N / A

$11,500 / $23,000

Traditional or true family?

Traditional

True family

Traditional

Traditional

Traditional

2024 In-Network Benefits
Preventive care

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%

Covered 100%, no deductible

Doctor's office visit

You pay $30 for PCP visit and $50 for specialist visit, no deductible

You pay 25% 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

You pay $25 for PCP visit and $40 for specialist visit, no deductible

Emergency room

You pay $150, then 30% after deductible

You pay 25% 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 $50

You pay 25% after deductible

You pay $40

You pay $40

You pay $25

Inpatient care

You pay 30% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 30%

If not an office visit, you pay 15% after deductible

Outpatient care

If not an office visit, you pay 30% after deductible

You pay 25% 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 Plus Silver Gold Gold II Platinum
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 $12 You pay 100% until you've met the deductible, then you pay 25% You pay $10 You pay $10 You pay $8
Tier 2 (generally medium cost options) You pay $60 You pay 100% until you've met the deductible, then you pay 25% You pay $40 You pay $40 You pay $30
Tier 3 (generally highest cost options) You pay $80 You pay 100% until you've met the deductible, then you pay 25% You pay $60 You pay $60 You pay $50
90-Day Mail Order Supply
Tier 1 (generally lowest cost options) You pay $30 You pay 100% until you've met the deductible, then you pay 25% You pay $25 You pay $25 You pay $20
Tier 2 (generally medium cost options) You pay $150 You pay 100% until you've met the deductible, then you pay 25% You pay $100 You pay $100 You pay $75
Tier 3 (generally highest cost options) You pay $200 You pay 100% until you've met the deductible, then you pay 25% 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. (Note: The Silver option available to out-of-area individuals is different than the Silver option on this site. Refer to asurion.benefitsnow.com for details.)

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.


Make It Yours To Go