Cost sharing is standardized in California. Covered California sets identical deductibles, copays and out-of-pocket maximums for every carrier within a metal tier, so what actually differs between carriers is premium, network and service area. See the 2026 side-by-side benefit designs, including the Enhanced Silver plans available under about 250% of the poverty level.
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| Bronze 60 HDHP HMO | Bronze 60 HMO | Bronze 60 HDHP HMO 5500/40% | |
| Deductible (Individual/Family) | $4,800 | $6,300 | $5,500/$11,000 |
| Out-of-Pocket Maximum (Individual/Family) | $6,550 | $6,800 | $6,500/$13,000 |
| Doctor Visit | |||
| Primary Care Office Visit | 40% after deductible | First 3 office visits $75 copay before deductible | 40% after deductible |
| Specialty Care Office Visit | 40% after deductible | $105 copay before deductible | 40% after deductible |
| Other Practitioner Office Visit | 40% after deductible | $75 copay before deductible | 40% after deductible |
| Preventive Care/Screening/Immunization | No charge | No charge | 40% after deductible |
| Tests | |||
| Lab Tests | 40% after deductible | $40 copay | 40% after deductible |
| X-Rays and Diagnostic Imaging | 40% after deductible | 100% coinsurance after deductible | No charge |
| Imaging (CT/PET Scans, MRIs) | 40% after deductible | 100% coinsurance after deductible | 40% after deductible |
| Drugs | |||
| Tier 1 (Most Generic Drugs) | 40% after deductible | 100% coinsurance after deductible | 40% after deductible, up to $500 per prescription |
| Tier 2 (Preferred Brand Drugs) | 40% after deductible | 100% coinsurance after deductible | 40% after deductible, up to $500 per prescription |
| Tier 3 (Non-Preferred Brand Drugs) | 40% after deductible | 100% coinsurance after deductible | 40% after deductible, up to $500 per prescription |
| Tier 4 (Specialty Drugs) | 40% after deductible | 100% coinsurance after deductible | 40% after deductible, up to $500 per prescription |
| Outpatient Services | |||
| Outpatient Facility Fee | 100% coinsurance after deductible | ||
| Outpatient Surgery Physician/Surgical Services | 100% coinsurance after deductible | ||
| Outpatient Services Office Visits | 100% coinsurance after deductible | ||
| ER & Urgent Care | |||
| Emergency Room Facility Fee | 100% coinsurance after deductible | ||
| Emergency Transportation | 100% coinsurance after deductible | ||
| Urgent Care | $75 copay before deductible | ||
| Emergency Room Professional Fee | no charge | ||
| Hospital | |||
| Inpatient Hospital Services | 100% coinsurance after deductible | ||
| Inpatient Physician and Surgical Services | 100% coinsurance after deductible | ||
| Mental/Behavioral Health Inpatient Facility Fee | 100% coinsurance after deductible | ||
| Mental/Behavioral Health Inpatient Professional Fee | 100% coinsurance after deductible | ||
| Substance Use Disorder Outpatient Services | $75 copay before deductible | ||
Silver
| Silver 70 HMO | Silver 70 HMO 1750/40 | Silver 70 HDHP HMO 2700/15% | |
| Deductible (Individual/Family) | $2,500/$5,000 | $1,750/$3,500 | $2,700/$5,400 |
| Out-of-Pocket Maximum (Individual/Family) | $6,800/$13,600 | $6,800/$13,600 | $6,500/$13,000 |
| Preventive Care | |||
| Routine physical exam, Mammograms, etc. | No charge | No charge | No charge |
| Primary Care Office Visit | $35 | $40 | 15% after deductible |
| Specialty Care Office Visit | $70 | $40 | 15% after deductible |
| Most X-rays | $70 | $60 | 15% after deductible |
| Most Lab Tests | $35 | $40 | 15% after deductible |
| MRI, CT, PET | $300 | $350 after deductible | 15% after deductible |
| Outpatient surgery | 20% | 30% after deductible | 15% after deductible |
| Mental Health Visit | $35 | $40 | 15% after deductible |
| Inpatient Hospital Care | |||
| Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care | 20% after deductible | 30% after deductible | 15% after deductible |
| Maternity | |||
| Routine prenatal care visit, first postpartum visit | No charge | No charge | No charge |
| Delivery and inpatient well-baby care | 20% after deductible | 30% after deductible | 15% after deductible |
| Emergency & Urgent Care | |||
| Emergency Department Visit | $350 | $350 after deductible | 15% after deductible |
| Urgent care visit | $35 | $40 | 15% after deductible |
| Prescription Drugs | |||
| Generic | $15 | $20 | 15% after deductible, up to $250 per prescription |
| Preferred Brand | $55 after $250 pharmacy deductible | $55 after $250 pharmacy deductible | 15% after deductible, up to $250 per prescription |
| Non-Preferred Brand | $55 after $250 pharmacy deductible | $55 after $250 pharmacy deductible | 15% after deductible, up to $250 per prescription |
| Specialty | 20% after $250 pharmacy deductible, upto $250 per prescription | 30% after $250 pharmacy deductible, up to $250 per prescription | 15% after deductible, up to $250 per prescription |
Gold
dd| Gold 80 HMO | Gold 80 HMO Coinsurance | |
| Deductible | None | None |
| Out-of-Pocket Maximum | $6,750 | $6,750 |
| Preventive Care | ||
| Routine physical exam, Mammograms, etc. | No charge | No charge |
| Primary Care Office Visit | $30 | $30 |
| Specialty Care Office Visit | $55 | $55 |
| Most X-rays | $55 | $55 |
| Most Lab Tests | $35 | $35 |
| MRI, CT, PET | $275 | 20% |
| Outpatient surgery | $655 | 20% |
| Mental Health Visit | $30 | $30 |
| Inpatient Hospital Care | ||
| Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care | $655 per day up to 5 days | 20% |
| Maternity | ||
| Routine prenatal care visit, first postpartum visit | No charge | No charge |
| Delivery and inpatient well-baby care | $655 per day up to 5 days | 20% |
| Emergency & Urgent Care | ||
| Emergency Department Visit | $325 | $325 |
| Urgent care visit | $30 | $30 |
| Prescription Drugs | ||
| Generic | $15 | $15 |
| Preferred Brand | $55 | $55 |
| Non-Preferred Brand | $55 | $55 |
| Specialty | 20% up to $250 per prescription | 20% up to $250 per prescription |
Platinum
| Platinum 90 HMO | |
| Deductible (Individual/Family) | None/None |
| Out-of-Pocket Maximum (Individual/Family) | $4,000/$8,000 |
| Preventive Care | |
| Routine physical exam, Mammograms, etc. | No charge |
| Primary Care Office Visit | $15 |
| Specialty Care Office Visit | $40 |
| Most X-rays | $40 |
| Most Lab Tests | $20 |
| MRI, CT, PET | $150 |
| Outpatient surgery | $290 |
| Mental Health Visit | $15 |
| Inpatient Hospital Care | |
| Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care | $290 per day up to 5 days |
| Maternity | |
| Routine prenatal care visit, first postpartum visit | No charge |
| Delivery and inpatient well-baby care | $290 per day up to 5 days |
| Emergency & Urgent Care | |
| Emergency Department Visit | $150 |
| Urgent care visit | $15 |
| Prescription Drugs | |
| Generic | $5 |
| Preferred Brand | $15 |
| Non-Preferred Brand | $15 |
| Specialty | 10% up to $250 per prescription |
Catastrophic
| Minimum Coverage HMO | |
| Deductible (Individual/Family) | $10,600/$14,300 |
| Out-of-Pocket Maximum (Individual/Family) | $10,600/$$14,300 |
| Preventive Care | |
| Routine physical exam, Mammograms, etc. | No charge |
| Primary Care Office Visit | First 3 office visits no charge. Additional visits no charge after deductible |
| Specialty Care Office Visit | No charge after deductible |
| Most X-rays | No charge after deductible |
| Most Lab Tests | No charge after deductible |
| MRI, CT, PET | No charge after deductible |
| Outpatient surgery | No charge after deductible |
| Mental Health Visit | First 3 office visits no charge. Additional visits no charge after deductible |
| Inpatient Hospital Care | |
| Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care | No charge after deductible |
| Maternity | |
| Routine prenatal care visit, first postpartum visit | No charge |
| Delivery and inpatient well-baby care | No charge after deductible |
| Emergency & Urgent Care | |
| Emergency Department Visit | No charge after deductible |
| Urgent care visit | First 3 office visits no charge. Additional visits no charge after deductible |
| Prescription Drugs | |
| Generic | No charge after deductible |
| Preferred Brand | No charge after deductible |
| Non-Preferred Brand | No charge after deductible |
| Specialty | No charge after deductible |
Coverage Areas
Northern California
2026 Kaiser Permanente (California) plans & member ratings
Kaiser Permanente offers individual plans through Covered California on its integrated care-and-coverage HMO model. In California, Covered California standardizes cost-sharing, so the deductible and out-of-pocket maximum for a given metal tier are the same at every carrier – the real differences are the network and the plan type. Figures below are the 2026 standardized single/individual medical values; premiums vary by age and county.
Gold 80 HMOPopular
No-deductible Gold HMO on Kaiser's integrated network.
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Rate all four categories – Cost, Plan Value, Customer Service and Network Size – to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.
Baseline: 3.6 / 5 – seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.
Silver 70 HMO
Standardized Silver HMO; best value with subsidies.
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Rate all four categories – Cost, Plan Value, Customer Service and Network Size – to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.
Baseline: 3.6 / 5 – seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.
Bronze 60 HDHP HMOHSA-eligible
HSA-qualified Bronze HMO for pairing with a health savings account.
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Rate all four categories – Cost, Plan Value, Customer Service and Network Size – to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.
Baseline: 3.8 / 5 – seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.
Bronze 60 HMOLowest premium
Standardized Bronze HMO for a lower monthly premium.
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Rate all four categories – Cost, Plan Value, Customer Service and Network Size – to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.
Baseline: 3.6 / 5 – seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.
Platinum 90 HMORichest coverage
No-deductible Platinum HMO with the lowest out-of-pocket max.
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Rate all four categories – Cost, Plan Value, Customer Service and Network Size – to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.
Baseline: 3.5 / 5 – seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.
Kaiser & California rate history
| Plan year | CA individual market (avg) | This carrier (approved) |
|---|---|---|
| 2019 | +8.7% | — |
| 2020 | +0.8% | — |
| 2021 | +0.5% | — |
| 2022 | +1.8% | — |
| 2023 | +5.6% | — |
| 2024 | +9.6% | — |
| 2025 | +7.9% | — |
| 2026 | +10.3% | +9.8% |
| 2027 (preliminary) | +9.9% | — |
Sources: Covered California 2026 rate announcement and standardized benefit designs; per-carrier 2026 change from Covered California (Kaiser had the lowest 2026 increase of the big carriers). Statewide column is the Covered California individual-market weighted average.
Kaiser's model is all-in-one – is that for you?
Kaiser members use Kaiser doctors and facilities, which many rate highly for coordination. A licensed agent can confirm Kaiser serves your area and compare it on Covered California, free. Call (855) 847-7020.