2025 2026

Compare 2026 Health Plans

Review up to 4 plans side-by-side to find the best coverage for your needs and budget.

Select Plans to Compare
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Feature
Bronze Bronze 60
Silver Silver 70
Gold Gold 80
Platinum Platinum 90
Deductibles
Individual Medical Deductible $5,800 $5,200 $0 $0
Individual Pharmacy Deductible $450 $50 $0 $0
Family Medical Deductible $11,600 $10,400 $0 $0
Family Pharmacy Deductible $900 $100 $0 $0
Care Visits
Preventive Care no charge no charge no charge no charge
Primary Care Visit $60 $50 $40 $15
Urgent Care Visit $60 $50 $40 $15
Specialty Care Visit $95 $90 $70 $30
Mental Health Therapy $60 $50 $40 $15
Tests & Therapy
Other Therapy $60 $50 $40 $15
Lab Testing $50 $50 $40 $15
X-Ray 40% $95 $75 $30
Advanced Imaging (CT/MRI) 40% $325 $75 or 25% $75 or 10%
Hospital & Emergency
Outpatient Services 40% 30% $190 or 30% $95 or 10%
Emergency Room 40% $400 $350 $175
Emergency Transport 40% $250 $250 $150
Prenatal Care no charge no charge no charge no charge
Inpatient Hospital 40% 30% $375 per day up to 5 days or 30% $225 per day up to 5 days or 10%
Hospital Physician 40% 30% $0 or 30% $0 or 10%
Prescription Drugs
Tier 1 (Generic) $20 $19 $18 $9
Tier 2 (Preferred Brand) 40% up to $500 $60 $60 $16
Tier 3 (Non-Preferred) 40% up to $500 $90 $85 $25
Tier 4 (Specialty) 40% up to $500 20% up to $250 20% up to $250 10% up to $250
Out-of-Pocket Maximums
Individual OOP Maximum $9,800 $9,800 $9,200 $5,000
Family OOP Maximum $19,600 $19,600 $18,400 $10,000
Understanding Deductibles and Benefit Costs

Benefits in Orange are Subject to the Annual Deductible amounts listed above. You will pay the full cost for these services until the Deductible is met. Then you will pay the specified amount that is shown until the Annual Maximum Out-of-Pocket is met. The deductible counts toward the Maximum Out-Of-Pocket.

Copays in Black are NOT Subject to any Deductible and count towards the Annual Maximum Out-Of-Pocket. The Annual Out-Of-Pocket Maximum and Deductible amounts are always based on the Individual amount listed even under a family plan. Two or more people in the family have to reach the family amounts listed above in order for them to apply to the entire family.

Tips for Choosing a Plan
  • Bronze Plans: Best if you're healthy and want lower monthly premiums.
  • Silver Plans: Good balance of premiums and out-of-pocket costs. May qualify for extra savings.
  • Gold Plans: Better if you use healthcare services frequently.
  • Platinum Plans: Highest premiums but lowest costs when you need care.

Understanding Health Plan Metal Tiers

Covered California health plans are organized into metal tiers—Bronze, Silver, Gold, and Platinum—that represent how you and your plan share the cost of your healthcare. This standardized system makes it easier to compare plans and find the right coverage for your situation. The metal tier tells you what percentage of healthcare costs the plan covers on average, while you pay the remainder through deductibles, copayments, and coinsurance.

Bronze 60% Coverage

Best for: Healthy individuals who rarely need medical care and want the lowest monthly premiums.

Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs when you need care. You'll pay more of your healthcare costs yourself through deductibles and copays. These plans typically have deductibles of $6,000-$7,000 for individuals. Bronze plans make sense if you're generally healthy, don't take regular medications, and want protection against worst-case scenarios like major accidents or serious illness.

Many Bronze plans are High-Deductible Health Plans (HDHPs) eligible for Health Savings Accounts (HSAs).

Silver 70% Coverage (73%, 87%, or 94% with CSR)

Best for: Most people, especially if you qualify for Cost-Sharing Reductions (CSR).

Silver plans offer a balanced approach between monthly premiums and out-of-pocket costs. More importantly, Silver is the only tier where you can receive Cost-Sharing Reductions if your household income is between 100% and 250% of the Federal Poverty Level. These CSR plans reduce your deductibles, copays, and out-of-pocket maximums significantly—effectively giving you Gold or Platinum-level coverage at Silver prices.

If you qualify for CSR, Silver plans offer the best value. Compare Silver 73, 87, and 94 plans in the selector above.

Gold 80% Coverage

Best for: People who use healthcare services regularly or take ongoing medications.

Gold plans have higher monthly premiums than Bronze or Silver but significantly lower costs when you receive care. With lower deductibles (typically $1,500-$3,000) and lower copays, you'll pay less out-of-pocket each time you visit a doctor, fill a prescription, or need lab work. Gold plans make financial sense if you see doctors frequently, manage chronic conditions, take multiple medications, or know you'll need surgery or other expensive procedures.

Calculate: If your expected healthcare costs exceed the premium difference, Gold saves you money.

Platinum 90% Coverage

Best for: Those who need frequent medical care or have high prescription drug costs.

Platinum plans have the highest monthly premiums but the lowest out-of-pocket costs when you receive medical care. With very low deductibles (often $0-$500) and minimal copays, you'll have predictable costs and maximum protection. Choose Platinum if you have ongoing health conditions requiring regular specialist visits, take expensive medications, are planning surgery, or simply want the peace of mind of paying as little as possible when you need care.

Maximum protection: Pay more monthly, pay less per visit.

How to Compare Plans Effectively

When comparing plans within the same tier, or across different tiers, focus on these key factors:

  • Total Annual Cost: Add your expected premiums plus estimated out-of-pocket costs (deductibles, copays, coinsurance). The plan with the lowest total is your best financial choice.
  • Deductible Amount: How much do you pay before the plan starts sharing costs? Can you afford this amount if you need care early in the year?
  • Out-of-Pocket Maximum: This is your financial safety net—the most you'll pay in a year. Essential protection against catastrophic costs.
  • Doctor Visit Copays: If you see doctors regularly, compare the copay amounts. A plan with $30 copays versus $60 copays saves $300 over 10 visits.
  • Prescription Drug Coverage: Look at copays for your specific medications' tier levels (generic, preferred brand, specialty).
  • Provider Network: Ensure your doctors and preferred hospitals are in-network (check the carrier's website).

Smart Shopping Tip

Use the comparison table above to evaluate 2-4 plans side-by-side. Start with plans in the tier that matches your healthcare usage, then compare a plan one tier higher and one tier lower to see if the premium difference is worth the change in out-of-pocket costs. Many Californians find that paying $50 more per month for a Gold plan instead of Silver saves them hundreds when they actually need care.

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