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Platinum Plans

Platinum plans usually have the highest monthly premium among coverage levels, but the lowest out-of-pocket costs when you get care. If you expect to use health care often, Platinum may be worth a closer look. Free preventive care is covered from day one.

Is Platinum right for you?

Platinum is the highest of Covered California's coverage levels. You'll pay the highest of any tier, but in return, your plan covers the largest share of your care. On average, your health insurance company pays about 90 percent of covered medical expenses, and you pay about 10 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 coverage begins (once you've made your first payment).

A Platinum plan may be a good fit if you:

  • Visit the doctor or specialists often.
  • Use prescriptions regularly.
  • Would rather pay the most each month so your costs are lowest when you get care.

You may want to consider other coverage levels if:

  • You rarely use health care.
  • You want a lower monthly premium.
  • You qualify for benefits.
  • You want a balance between your monthly premium and what you pay for care.

Compare all coverage levels to find the right fit.

Plan types: HMO, PPO and EPO

You've picked Platinum. 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 Platinum 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 Platinum HMO, you pay a set amount for things like imaging, home health and hospital stays. With a Platinum EPO or PPO, you pay a percentage of the bill instead. With Platinum, there’s no medical or pharmacy deductible, so your plan helps pay from day one. What you pay for prescriptions 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)
$5,000
$5,000
Out-of-pocket maximum (family)
$10,000
$10,000
Medical deductible
$0
$0
Pharmacy deductible
$0
$0
Doctor visit
$15
$15
Specialist visit
$30
$30
Mental health outpatient visit
$15
$15
Urgent care
$15
$15
Emergency room
$175
$175
Ambulance
$150
$150
Lab visit / lab tests
$15
$15
X-rays and diagnostic imaging
$30
$30
CT/PET scans, MRIs
$75
10% of bill
Home health
$20 per visit
10% of bill
Durable medical equipment
10% of bill
10% of bill
Skilled nursing care
$125 per day, up to 5 days
10% of bill
Hospital facility fee
$225 per day, up to 5 days
10% of bill

Drug lists can change. Check your medication's tier with your health insurance company or in Shop and Compare before choosing a plan.


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.

  • Health Plan 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.