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Gold Plans

Gold plans cost more each month, but you'll know what you'll pay from day one. With set prices and no deductibles to meet first, Gold is a good fit if you see the doctor often or want fewer surprises when you get care.

Is Gold right for you?

Gold sits between Silver and Platinum on Covered California's . You'll pay a higher monthly than you would with a Bronze or Silver plan, but in exchange, your plan covers a larger share of your care. On average, your health insurance company pays about 80 percent of covered medical expenses, and you pay about 20 percent.

The biggest perk: no medical or pharmacy . You don't have to spend a set amount before your plan starts paying its share, so are available from the first day your plan begins.

A Gold plan may be a good fit if you:

  • Visit the doctor or specialists several times a year.
  • Use prescriptions regularly.
  • Would rather pay more each month so your costs are lower at the doctor or pharmacy.
  • Want predictable costs and no deductible.

You may want to consider other coverage levels if you:

  • Rarely use health care.
  • Want a lower monthly premium.
  • Qualify for benefits.
  • Want the lowest possible costs for care and don't mind a higher monthly premium.

Compare all coverage levels to find the right fit.

Plan types: HMO, PPO and EPO

You've picked Gold. That sets your overall costs. Now pick a plan type: HMO, PPO or EPO. Your choice changes how you see doctors, whether you need a referral and what you pay each month.

  • HMO Plans

    Health maintenance organization

    Lower cost, more structure

    • Only covers in-network care, except for emergencies
    • Need a referral to see a specialist
    • Usually the lowest monthly premium

    BEST FOR

    Lower costs, with a primary doctor managing your care

  • PPO Plans

    Preferred provider organization

    More choice, higher cost

    • See doctors in or out of the network
    • No referral needed to see a specialist
    • Higher monthly premium than HMO or EPO

    Best For

    Flexibility to choose your own doctors and hospitals

  • EPO Plans

    Exclusive provider organization

    Part HMO, part PPO

    • Only covers in-network care, except for emergencies
    • No referral needed to see a specialist
    • Costs usually land between HMO and PPO

    BEST FOR

    Lower costs without needing referrals

What You’ll Pay

Every Gold plan covers your care at the same level. The plan type changes how you get care and how you pay for some services. With a Gold HMO, you pay a set amount for things like imaging, home health and hospital stays. With a Gold EPO or PPO, you pay a percentage of the bill instead. With Gold, there's no pharmacy deductible, so your plan helps pay for prescriptions from day one. What you pay depends on the drug's tier: generic drugs cost the least, and specialty drugs cost the most.

Service
Service
What You Pay - HMO
What You Pay - PPO and EPO
Out-of-pocket maximum (individual)
$9,200
$9,200
Out-of-pocket maximum (family)
$18,400
$18,400
Medical deductible
$0
$0
Pharmacy deductible
$0
$0
Doctor visit
$40
$40
Specialist visit
$70
$70
Mental health outpatient visit
$40
$40
Urgent care
$40
$40
Emergency room
$350
$350
Ambulance
$250
$250
Lab visit / lab tests
$40
$40
X-rays and diagnostic imaging
$75
$75
CT/PET scans, MRIs
$75
25% of bill
Home health
$30 per visit
20% of bill
Durable medical equipment
20% of bill
20% of bill
Skilled nursing care
$150 per day, up to 5 days
30% of bill
Hospital facility fee
$375 per day, up to 5 days
30% of bill

Want to know what you'll pay, including your monthly premium? Shop and Compare plans and prices in your area.

Ready to compare plans?

See plans available in your area. Compare monthly premiums, doctors, hospitals, prescription costs and estimated savings.

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Keep Exploring

Not ready to pick a plan yet? Here are a few ways to learn more or get help.

  • Explore All Coverage Levels

    No matter which level you choose, the basics are covered, like doctor visits, prescriptions and mental health care. Find your fit.

  • What is Financial Help?

    Most Californians get help paying for their plan. See how savings work and who’s eligible.

  • Find Free Local Help

    Picking a plan can feel overwhelming. 11,000 enrollers are here to answer your questions and help you apply at no cost.