California Exchange

The California Exchange, named Covered California, was conditionally approved by the US Department of Health and Human Services in January of 2013.

Types of Plans Offered

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Covered California offers “Qualified Health Plans,” which are guaranteed to provide certain levels of coverage, including the ten categories of essential health benefits, required under the Affordable Care Act (ACA).  There are four metal tiers of coverage:

  • Bronze – covers approximately 60 percent of the value of covered benefits
  • Silver – covers approximately 70 percent of the value of covered benefits
  • Gold – covers approximately 80 percent of the value of covered benefits
  • Platinum – covers approximately 90 percent of the value of covered benefits

Platinum and Gold plans will generally have higher monthly premiums and will require individuals to pay less in out-of-pocket costs for the medical services they receive.  Alternatively, individuals may choose to lower their monthly premiums and purchase the Silver or Bronze plan but will pay more in out-of-pocket costs when they receive care.

In addition to these four metal tiers, Covered California offers a “Minimum Coverage” or “Catastrophic Coverage” plan for those up to age 30.  This type of plan usually has lower premiums and covers three doctor visits or urgent care visits with no out-of-pocket costs plus free preventive service benefits.  All other services are the responsibility of the insured and billed at full cost for in-network services up to $6,350.  Once the maximum is reached, all in-network services are covered at 100 percent.