1. Covered California
Individual Exchange Analysis
Bronze 60
Age
25
35
45
55
Marriage
Status
Income
Anthem Multi State Plan
PPO
Anthem Multi State Plan
HMO
Blue Shield of CA
PPO
Kaiser Permanente
HMO
Single
Family
Single
Family
Single
Family
Single
Family
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$200
$652
$243
$738
$287
$827
$443
$1,139
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
$240
$741
$276
$839
$345
$993
$532
$1,368
$227
$783
$292
$887
$326
$939
$504
$1,294
Silver 70
Age
25
35
45
55
Marriage
Status
Income
Anthem Multi State Plan
PPO
Anthem Multi State Plan
HMO
Blue Shield of CA
PPO
Kaiser Permanente
HMO
Single
Family
Single
Family
Single
Family
Single
Family
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$267
$872
$325
$988
$384
$1,106
$593
$1,524
$270
$881
$325
$998
$388
$1,117
$599
$1,540
$290
$984
$353
$1,074
$417
$1,202
$645
$1,656
$304
$993
$370
$1,125
$437
$1,259
$675
$1,735
Gold 80
Age
25
35
45
55
Marriage
Status
Income
Anthem Multi State Plan
PPO
Anthem Multi State Plan
HMO
Blue Shield of CA
PPO
Kaiser Permanente
HMO
Single
Family
Single
Family
Single
Family
Single
Family
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$321
$1,048
$391
$1,187
$462
$1,329
$713
$1,832
$338
$1,102
$411
$1,249
$486
$1,398
$750
$1,927
$342
$1,116
$416
$1,264
$491
$1,415
$759
$1,950
$370
$1,207
$480
$1,367
$532
$1,531
$821
$2,109
Platinum 90
Age
25
35
45
55
Marriage
Status
Income
Anthem Multi State Plan
PPO
Anthem Multi State Plan
HMO
Blue Shield of CA
PPO
Kaiser Permanente
HMO
Single
Family
Single
Family
Single
Family
Single
Family
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$50,000
$100,000
$372
$1,215
$453
$1,377
$535
$1,541
$827
$2,124
$386
$1,260
$470
$1,428
$555
$1,598
$857
$2,202
$392
$1,278
$477
$1,449
$563
$1,622
$870
$2,235
$397
$1,298
$484
$1,470
$572
$1,646
$883
$2,268
We do not make any representations or guarantees with respect to the accuracy of any of the information provided
The health insurance industry is ever evolving with polices, amendments thereto and other changes occurring continuously.
Only information provided directly from CoveredCA.com or in a policy or other writing from the insurance carrier can be relied on for its complete accuracy.
Expertquote Insurance Services, Inc. will not be liable for any damages of any kind arising from the use of information including, but not limited to direct, indirect, incidental, punitive, and/or consequential damages.

2. Plan Summary
Bronze 60
Silver 70
Key Benefits
Benefits in Bold are Subject to Deductibles
Deductable
Maximum Out-of-Pocket
Individual
Maximum Out-of-Pocket
Family
Preventative
Care Copay
Primary Care
Visit Copay
Specialty Care
Visit Copay
Urgent Care
Visit Copay
Lab Testing
Copay
X-Ray Copay
Emergency Room
Copay
High Cost and
HMO
Infrequent
PPO
Services
Generic Medication
Copay
Preferred Brand Copay
after Drug Deductible
Gold 80
Platinum 90
Copays NOT Bold are Not Subject to any
Deductable and Count Toward the Annual Out-ofPocket Maximum
$5,000
for medical and drugs
$2,000
for medical and drugs
No deductible
No deductible
$6,350
$6,350
$6,350
$4,000
$12,700
$12,700
$12,700
$8,000
No cost,
at least one yearly visit
No cost,
at least one yearly visit
No cost, at least one yearly No cost, at least one yearly
visit
visit
(in-network only)
(in-network only)
$60, three visits per year
$45
$30
$20
$70
$65
$50
$40
$120
$90
$60
$40
30%
$45
$30
$20
30%
$65
$50
$40
$300
$250
$250
$150
30% of plan's
negotiated rate
20% of plan's
negotiated rate
$19
$50
Outpatient Surgery - $600,
Outpatient Surgery - $250,
Hospital $600/day, 5 day max Hospital $250/day, 5 day max
20%
10%
$19
$19
$5
$50
$50
$15
We do not make any representations or guarantees with respect to the accuracy of any of the information provided
The health insurance industry is ever evolving with polices, amendments thereto and other changes occurring continuously.
Only information provided directly from CoveredCA.com or in a policy or other writing from the insurance carrier can be relied on for its complete accuracy.
Expertquote Insurance Services, Inc. will not be liable for any damages of any kind arising from the use of information including, but not limited to direct, indirect, incidental, punitive, and/or consequential damages.