Which Covered California Plan Is Best for Me? The standardized health plans sold through the Covered California health insurance marketplace are offered at five different levels of coverage: Bronze, Silver, Gold, and Platinum, and a Catastrophic plan for those who qualify. Bronze plans typically have the lowest premiums but cover the least, while Platinum plans typically have the highest premiums but offer the most coverage. Here’s a quick breakdown: Bronze -- 60/40 (Plan pays 60% of covered expenses; patient pays 40%) Silver -- 70/30 (Plan pays 70% of covered expenses; patient pays 30%) Gold -- 80/20 (Plan pays 80% of covered expenses; patient pays 20%) Platinum -- 90/10 (Plan pays 90% of covered expenses; patient pays 10%) Catastrophic -- (Plan pays less than 60% of the total average costs of care, on average; patient pays the remainder In order to estimate your total healthcare costs, it’s important to look beyond premium alone: First, because virtually every healthcare plan has out-of-pocket costs in the form of copayments, deductibles, and/or coinsurance amounts; and, second, because your costs can vary according to where you live, as well as the providers and treatments you use, and your current health. When deciding on a plan, consider the following: Whether you have any chronic conditions or issues that require regular doctor visits How many times per year you normally see or expect to see your doctor in the coming year The number of lab tests you expect to have in the coming year How many prescriptions medications you currently take, if any If you are healthy and normally see a doctor very infrequently, a Bronze-level plan is likely your best option for keeping premium costs down. If, on the other hand, you take several prescription medications and see a doctor fairly frequently, and/or you have a chronic condition that requires regular medical care, a Silver or Platinum plan may better serve you. It’s important to note that all plans purchased through Covered California place caps on the amount an insured person can spend out-of-pocket each year for covered health expenses. This is referred as an annual out-of-pocket maximum. Let’s look at an example: If Leonard chooses a Bronze-level plan on which all of his plan’s deductibles, copayments, and coinsurance amounts count toward his out-of-pocket maximum of $6,350, his health care costs cannot exceed that amount for the year. If Leonard had an accident and was hospitalized for 30 days (hospitalizations can be enormously expensive) the most he would pay is $6,350. Premium Tax Credits and Cost-Sharing Subsidies
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