Which Coverage Level Is Best?
You get to choose how much coverage you need and how you want to pay for it. When you choose your coverage level, you get to pick the one with the features you want. If you’re enrolling again, consider what changes you may be facing. Change is constant, so make sure you do your homework before sticking with what you had in the past.
Your coverage level determines how much you pay out of your paycheck (premiums). It also determines how much you pay out of your pocket when you receive care (deductibles, coinsurance, copays).
Don’t let the names of the coverage levels fool you. One option isn’t better than another. The coverage levels are designed to give you choices. It’s up to you to find the one that makes sense for your situation.
Medical Coverage Level Options
You have several coverage levels to choose from. Each coverage level is available from different insurance carriers at different costs.
When you enroll, you’ll find plenty of tools and resources to help you choose a coverage level.
| Bronze | Bronze Plus | Silver | Gold | Platinum | |
|---|---|---|---|---|---|
| Option type | High-deductible option with HSA | High-deductible option with HSA | PPO | PPO | PPO that offers limited benefits for out-of-network care** |
| Paycheck contributions | $ | $ | $$ | $$$ | $$$$ |
| In-network (individual / family) | $3,300 / $6,600 | $2,500 / $5,000 | $1,000 / $2,000 | $800 / $1,600 | $250 / $500 |
| Out-of-network (individual / family) | $3,300 / $6,600 | $2,500 / $5,000 | $2,000 / $4,000 | $1,600 / $3,200 | $5,000 / $10,000 |
| Traditional or true family? | Traditional | True family | Traditional | Traditional | Traditional |
| In-network (individual / family) | $6,400 / $12,800 | $4,500 / $9,000 | $5,300 / $10,600 | $3,600 / $7,200 | $2,300 / $4,600 |
| Out-of-network (individual / family) | $12,800 / $25,600 | $11,500 / $23,000 | $10,600 / $21,200 | $7,200 / $14,400 | $11,500 / $23,000 |
| Traditional or true family? | Traditional | True family | Traditional | Traditional | Traditional |
| Preventive care | Covered 100%, no deductible | Covered 100%, no deductible | Covered 100%, no deductible | Covered 100%, no deductible | Covered 100%, no deductible |
| Doctor's office visit | You pay 25% after deductible | You pay 25% after deductible | You pay $30 for PCP visit and $50 for specialist visit, no deductible | You pay $25 for PCP visit and $40 for specialist visit, no deductible | You pay $25 for PCP visit and $40 for specialist visit, no deductible |
| Emergency room | You pay 25% after deductible | You pay 25% after deductible | You pay $150, then 30% after deductible | You pay $150, then 20% after deductible | You pay $150, then 15% after deductible |
| Urgent care | You pay 25% after deductible | You pay 25% after deductible | You pay $50 | You pay $40 | You pay $25 |
| Inpatient care | You pay 25% after deductible | You pay 25% after deductible | You pay 30% after deductible | You pay 20% after deductible | You pay 15% after deductible |
| Outpatient care | You pay 25% after deductible | You pay 25% after deductible | If not an office visit, you pay 30% after deductible | If not an office visit, you pay 20% after deductible | If not an office visit, you pay 15% after deductible |
Prescription Drug Coverage
| Bronze | Bronze Plus | Silver | Gold | Platinum | |
|---|---|---|---|---|---|
| Preventive drugs | You pay $0** | You pay $0** | You pay $0** | You pay $0** | You pay $0** |
| Tier 1 (generally lowest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $12 | You pay $10 | You pay $8 |
| Tier 2 (generally medium cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $50 | You pay $40 | You pay $30 |
| Tier 3 (generally highest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $70 | You pay $60 | You pay $50 |
| Tier 1 (generally lowest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $30 | You pay $25 | You pay $20 |
| Tier 2 (generally medium cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $125 | You pay $100 | You pay $75 |
| Tier 3 (generally highest cost options) | You pay 100% until you've met the deductible, then you pay 25% | You pay 100% until you've met the deductible, then you pay 25% | You pay $175 | You pay $150 | You pay $125 |
California Residents: Your options will be different, depending on the insurance carrier you choose. See what's different.
Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier.
Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You may need to designate a primary care physician to coordinate your care if you choose Kaiser Permanente or Health Net as your insurance carrier.
Do You Take Any Prescription Drugs?
Your prescription drug coverage will be provided through your insurance carrier’s pharmacy benefit manager.
While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how your family's medications will be covered. Get the details.
Questions?
Check out the Frequently Asked Questions (PDF) and the Glossary.
