Based on income, some Californians will qualify for cost-sharing reductions with an Enhanced Silver Plan. These plans reduce costs to see a doctor, get a prescription filled, etc. Below is the breakdown of benefits associated with plans in each metal tier.

Bronze
Silver
Gold
Platinum
Key Benefits
Benefits in Blue are subject to deductibles
Copays in Black are not subject to any deductible and count toward the annual out-of-pocket maximum.
Individual Deductible
$5,000deductible for medical and drugs
$2,000 medical deductible
$250 brand drug
deductible
No Deductible
No Deductible
Family Deductible
$10,000deductible
$4,000 medical deductible
$500 brand drug
deductible
No Deductible
No Deductible
Preventative Care Copay1
(Deductible does not apply)
No Cost
No Cost
No Cost
No Cost
Primary Care Visit Copay
$602
$45
$30
$20
Specialty Care Visit Copay
$70
$65
$50
$40
Urgent Care Visit Copay
$1202
$90
$60
$40
Generic Medication Copay
$15
$15
$15
$5
Lab Testing Copay
30%
$45
$30
$20
X-Ray Copay
30%
$65
$50
$40
Emergency Room Copay
$300
$250
$250
$150
High Cost and Infrequent Services (e.g. Hospital Stay)
30% of your plan's negotiated rate
20% of your plan's negotiated rate
HMO
Outpatient Surgery-$600 Hospital-$600⁄day up to 5 days

PPO-20%
HMO
Hospital-$250/day up to 5 days

PPO-10%
Preferred Brand Copay After Drug Deductible (if any)
$50
$50
$50
$15
Maximum Out-of-Pocket for Individuals
$6,250
$6,250
$6,250
$4,000
Maximum Out-of-Pocket for Families
$12,500
$12,500
$12,500
$8,000
1 In-network Only
2 First 3 visits each year are not subject to the deductible
Some individuals may qualify for an Enhanced Silver plan based on income. When a qualified individual chooses a Silver plan, they will have out-of-pocket savings through lower co-pays, co-insurance and deductibles.
Individuals in these categories will get the out-of-pocket savings benefit of a Gold or Platinum plan for a Silver plan price. With an Enhanced Silver plan, on average, the plan pays 93%, 87% or 73% of expenses in total for covered benefits, with enrollees responsible for the rest. To learn more about Enhanced Silver plans, call us or visit the Enhanced Silver Plans page.
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