What Kind of Health Plans Are Offered Through Covered California?
All plans sold through Covered California are private health plans, and required to cover these essential health benefits: ambulatory patient services (aka X-rays, blood tests, immunizations), hospitalization, emergency services, maternity and newborn care, mental health, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, chronic disease management, and pediatric dental and vision care.
In Shasta County, we have an Anthem PPO and Blue Shield EPO option to pick from. There are four standard categories of health plans offered by Anthem and Blue Shield, otherwise known as metal tier plans, and they each cover a certain percentage of out-of-pocket costs. The Bronze and Silver plans will also include a Health Savings Account (HSA) plan option to pick from.
Bronze 60: $5000 Deductible (covers 60% out-of-pocket costs)
Silver 70: $2000 Deductible (covers 70% out-of-pocket costs)
Gold 80: $0 Deductible (covers 80% out-of-pocket costs)
Platinum 90: $0 Deductible (covers 90% out-of-pocket costs)
Adults Under 30 are also eligible to enroll in a Catastrophic Plan that is less expensive than the Bronze plan.
The Silver plan level also includes three cost-sharing assistance plan options, which reduce the plan deductible, co-pays, and max out-of-pocket offered to lower income ranges as a secondary subsidy beyond the premium assistance (tax credit). Here is a quick look at the income range for an individual qualifying for the 3 "Cost-Sharing Assistance" Silver plan options:
Individual Income Range for Cost-Sharing Assistance Silver Plans:
$15,856 - $17,235: Silver 94 - $0 Deductible
$17,235 - $22,980: Silver 87 - $500 Deductible
$22,980 - $28,725: Silver 73 - $1500 Deductible
Covered California offers a Shop and Compare Tool on their website http://www.coveredca.com to preview plan cost and benefit options and eligibility for premium assistance and possible cost-sharing assistance. You can also contact your local certified health insurance agent to help navigate the Covered California website and potential eligibility based on household income and family size.