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Heidi’s House

Covered California

You may qualify for help paying your premium.

Most Covered California households qualify for financial assistance based on income — many pay far less than the sticker price. As a Covered California Certified Insurance Agent, I can check your eligibility and complete your 2026 enrollment with you, at no cost.

Call (949) 204-6320or email insured@healthheidi.com

What 2026 plans cost to use, tier by tier

Covered California standardizes benefits, so every carrier’s Silver plan (for example) has the same copays and deductibles — you’re choosing a doctor network and a price, not fine print. If your income falls in a Silver 73/87/94 range, the state quietly upgrades your plan at no extra premium. Scroll the table sideways to compare tiers.

2026 Covered California Patient-Centered Benefit Designs and Medical Cost Shares by plan tier
Coverage categoryMinimum CoverageBronzeSilverSilver 73Silver 87Silver 94GoldPlatinum
Percent of cost coverage0% until out-of-pocket max is met60% average annual cost70% average annual cost73% average annual cost87% average annual cost94% average annual cost80% average annual cost90% average annual cost
Cost-sharing reduction income range (single)———$31,301–$39,125 (>200% to ≤250% FPL)$23,476–$31,300 (>150% to ≤200% FPL)up to $23,475 (>100% to ≤150% FPL)——
Free preventive care visit$0$0$0$0$0$0$0$0
Primary care visitFull cost after first 3 non-preventive visits, until out-of-pocket max$60$50$50$15$5$40$15
Urgent careFull cost after first 3 non-preventive visits, until out-of-pocket max$60$50$50$15$5$40$15
Specialist visitFull cost per service until out-of-pocket max$95*$90$90$25$8$70$30
Emergency room facilityFull cost per service until out-of-pocket max40% after deductible$400$400$200$50$350$175
Laboratory testsFull cost per service until out-of-pocket max$50$50$50$30$10$40$15
X-rays and diagnosticsFull cost per service until out-of-pocket max40% after deductible$95$95$50$10$75$30
ImagingFull cost per service until out-of-pocket max40% after deductible$325$325$100$50$75 copay or 25% coinsurance***$30 copay or 10% coinsurance***
Tier 1 (generic drugs)Full cost per script until out-of-pocket max$20$19$19$8$3$18$9
Tier 2 (preferred drugs)Full cost per script until out-of-pocket max40% up to $500/script after drug deductible$60**$55**$25**$10$60$16
Tier 3 (non-preferred drugs)Full cost per script until out-of-pocket max40% up to $500/script after drug deductible$90**$85**$45**$15$85$25
Tier 4 (specialty drugs)Full cost per script until out-of-pocket max40% up to $500/script after drug deductible20% up to $250**/script20% up to $250**/script15% up to $150**/script10% up to $150/script20% up to $250/script10% up to $250/script
Medical deductible—$5,800 individual / $11,600 family$5,200 individual / $10,400 family$5,200 individual / $10,400 family$1,400 individual / $2,800 family———
Pharmacy deductible—$450 individual / $900 family$50 individual / $100 family$50 individual / $100 family$50 individual / $100 family———
Annual out-of-pocket maximum$10,600 individual / $21,200 family$9,800 individual / $19,600 family$9,800 individual / $19,600 family$8,100 individual / $16,200 family$3,350 individual / $6,700 family$1,400 individual / $2,800 family$9,200 individual / $18,400 family$5,000 individual / $10,000 family

Drug prices are for a 30-day supply. * Specialist copay applies to the first three visits; after that, full cost until the medical deductible is met. ** Price is after the pharmacy deductible is met. *** See the plan’s Evidence of Coverage for imaging cost share.

Source: Covered California 2026 Patient-Centered Benefit Designs (PDF). Income ranges shown are for a single-person household.

Ask Heidi about Covered California

Tell me a little about your household and I’ll reply with your options and what financial help you qualify for.

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Official resources