ACA

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AFFORDABLE CARE ACT (ACA)

California opted to create its own exchange called Covered California.  Covered California
offers 4 plan tiers similar to the Federal Plan; Bronze, Silver, Gold & Platinum.
The plan summaries can be found at the bottom of this page.

  FPL 138% of FPL 400% of FPL
Family Size Gross Income Gross Income Gross Income
1 <$12,880 <$17,774 <$51,520
2 <$17,420 <$24,040 <$69,680
3 <$21,960 <$30,305 <$87,840
4 <$26,500 <$36,570 <$106,000
5 <$31,040 <$42,835 <$124,160
6 <$35,580 <$49,100 <$142,320

Many Californians will qualify for a premium credit if they earn less than 400% of the Federal Poverty Level (FPL) or MediCal at less than 138% of poverty level.
PLAN Bronze 60 Silver 70 Gold 80 Platinum 90
(Benefits in Blue are Subject to Deductibles) (Copays in Black are Not Subject to any Deductible and Count Toward the Annual Out-of-Pocket Maximum) www.hyehealth.com
Deductible $6,000-
$7000
deductible for medical & drugs 		$2000 medical deductible $250 brand drug  deductible no deductible no deductible
Preventative Care Copay (Deductible does not apply) no cost at least 1 yearly visit no cost at least 1 yearly visit no cost at least 1 yearly visit no cost at least 1 yearly visit
Primary Care Visit Copay $65 3 visits per year $40-$50 $35 $15
Specialty Care Visit Copay $95 $80-$90 $65 $30
Urgent Care Visit Copay $65 $40 $35 $15
Generic Medication $18 $16 $15 $5
Lab Testing Copay $40 $40 $40 $15
X-Ray Copay 40% $85 $75 $30
Emergency Room Copay $300 $400 $350 $150
High cost and infrequent services (e.g. Hospital Care) 40%of your plan’s negotiated rate 20-30% of your plan’s negotiated rate HMO Outpatient Surgery & Hospitalization –
Flat rate

PPO – 20%

HMO Outpatient Surgery & Hospitalization –
Flat rate

PPO – 10%

Preferred brand copay after Drug Deductible (if any) 40% $15-$90 $15-$80 $5-$25
Maximum Out-of-Pocket For One $8,200 $8,200 $8,200 $4,500
Maximum Out-of-Pocket For Family $16,400 $16,400 $16,400 $9,000
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