The chart below provides an estimate of the out-of-pocket cost for each person, each month. If you are Very Healthy or Healthy, your out-of-pocket costs are expected to be much lower than if you are Managing Chronic Conditions or Managing Complex Health Conditions.

Here is an example for a family of three. It shows the cost of paying the insurance premium and paying for out-of-pocket services:

Family member
Adult - 35 years old
Adult - 30 years old
Child - 13 years old
Combined Family
Monthly premium Silver less premium assistance for family
$244
$226
$127
$597
­-$254
TOTAL MONTHLY PREMIUM AFTER ASSISTANCE
$343
Health Status
Healthy
Very Healthy
Managing Chronic Condition
Managing Complex Chronic Condition
Estimated monthly out-of-pocket
$67
$25
$150
$242
Total expected monthly cost for family combining monthly premium after assistance and estimate of out-of-pocket costs
$585

When you are ready to enroll at CoveredCA.com you will be able shop and compare plan options that include the estimated out-of-pocket costs. You may find that a plan with a higher up front premium is a better overall value once you consider the out-of-pocket costs.

Estimates of your monthly Out-of-Pocket costs for Health Care Services


Your Health Status

Very Healthy

Healthy
Managing Chronic Conditions
Managing Complex Health Conditions
PERCENT OF POPULATION
Combined 65% - 70%
20% - 25%
5% - 10%
Average health care services used each year
1 illnesss or injury per year (office visit, lab test, plus medication)
Regular check-ups with lab tests or x-rays, 1 illness or injury each year, 1 routine medication
Monthly doctor visits, periodic lab and diagnostic tests, and 3 routine medications
2+ doctor visits per month, 4+ medications, outpatient services, services and 1 more hospitalizations
STANDARD PLANS
Platinum90
$8
$33
$83
$333
Gold80
$17
$50
$117
$529
Silver70
$25
$67
$150
$529
Bronze60
$50
$150
$375
$529
Min. Coverage Plan
$50
$150
$375
$529
ENHANCED SILVER PLANS
Silver94
$2
$5
$17
$188
Silver87
$8
$25
$58
$188
Silver73
$17
$58
$125
$433
Silver70
$25
$67
$150
$529