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Gold Coverage

No surprises or deductibles. Count on set prices from day one.

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Coverage

for pre-existing conditions

80%

of costs paid by your insurance company

Free

preventive care

$0

deductibles

Free

preventive children’s dental and vision

Choose Your Household Type

an individual
a family together

$8,200

Out-of-Pocket Maximum

$0

Medical Deductible

$0

Pharmacy Deductible

$16,400

Out-of-Pocket Maximum

$0

Medical Deductible

$0

Pharmacy Deductible

Three Types of Plans to Choose From

(depending on location and company)

a doctor holding a patients hands

HMO Plans

Get coordinated care from doctors and hospitals in the same network. Out-of-network services are only covered for urgent or emergency care.

a mom, dad, and child smiling

PPO Plans

Enjoy flexibility in selecting your doctors and hospitals in your plan's network. Out-of-network services are covered, usually at a higher cost.

a woman smiling at her phone

EPO Plans

See in-network specialists without getting a referral first, with monthly premiums that are usually lower than those of PPO plans. Restrictions apply to out-of-network services.

Every Plan Comes With

Free Preventive Care

Your health plan isn’t just there for you when you’re sick. Stay healthy with annual checkups, vaccines, screenings and more — all at no extra cost to you.

Free

From the first day you enroll

Transparent

All insurance companies offer the same preventive services

$0

Well-woman visits

Personalized

Free preventive care tailored to every age.

The Gold Standard

All plans in the Gold level have the same benefits. Compare plans on things like price and hospital location with the peace of mind that benefits are guaranteed.

a heart beat inside of a stethescope

Preventive Care

Enjoy free services, like checkups and screenings.

a bear with a stethescope around it's shoulders

Pediatric Care

Free vision care and preventive dental care for children.

a clipboard and a shield with a medical cross in it

Follow-Up Care

Ensure you’re on the path back to good health.

a person with a stethescope around their neck

Doctor Visits

No surprises: set prices every time you visit the doctor.

an ambulance

Emergency Services

Care when you need it most — that you won’t go into debt over.

a pill bottle with a pill next to it

Pharmacy

No drug deductible. Your plan helps cover prescriptions from the get-go.

Frequently asked questions about Covered CA

Is Gold right for me?

Gold plans often have high monthly costs, but when you receive care, your costs will be lower. They are a good fit for people who are moderate or heavy users of health services. People who get care often may be interested in the Platinum level, which has even cheaper prices at the point of service. On the other hand, if you think you need less medical attention, Silver and Bronze plans usually have lower monthly costs but higher costs when you get care.

Free preventive services in all Gold plans include annual checkups, certain screenings, immunizations, prenatal care, children’s vision care and preventive and diagnostic children’s dental care.

What are copays, deductibles and coinsurance?

Copays are a fixed out-of-pocket amount paid for covered services. Insurance providers often charge copays for services such as doctor visits or prescription drugs.

Your deductible is the amount you pay out of pocket for health care services covered under your insurance plan before your plan begins to pay for eligible expenses. The amount you pay for a health insurance deductible is determined by the type of plan you choose.

Coinsurance is your share of costs for a covered health care service after the deductible is reached. It’s calculated as a percentage.

What if I want to schedule a Wellness Checkup?

Be sure the doctor or provider you want to see is participating in your health plan network. If you visit the provider before you receive your membership ID card, you may be asked to sign a statement agreeing to pay for the services if you can’t prove you have health insurance.

The provider may later send you a bill for the care. By the time you get a bill or claim from your provider, you will most likely already be entered into your health insurance company’s system. Once you have your membership ID card, simply contact your provider, provide them your membership ID card number and ask to have the bill resubmitted directly to your health insurance company.

Do I need to select a Primary Care Doctor?

Your plan may require you to have a primary care clinician. Your primary care clinician will help you navigate the health care system when you need assistance with specialty care, coordinating your care with other providers and helping you understand your treatment options. You can change your primary care clinician at any time.

What if I need to change my health insurance while getting treatment?

If your new health insurance does not work with your doctor, but you are getting treatment for a serious condition, call your new health insurance company to let them know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health insurance company may be able to work with your current doctor while you finish treatment. Be sure to tell your current doctor that you have new health insurance.

How do I get prescriptions filled?

For questions about medications and getting your prescriptions filled, the first step is to contact your health insurance company to see if it has received your first payment and can issue you a membership ID card or a plan identification number. Ask which pharmacies you can use in order to get the pharmacy benefits of your health insurance plan.

What should I do if my income changes?

When the information that you put on your application changes during the year, you must report it. Changes to things like your address, family size and income can affect whether you qualify for Medi-Cal or get help paying for your health insurance through Covered California.

People with Medi-Cal must report changes to their local county office within 10 days of the change. If you have health insurance through Covered California, you must report changes within 30 days.

How do I make sure my preventative care is free?

Preventive care doctor visits are free, but if you bring up a health concern during the appointment, the visit may turn into a traditional doctor visit. That means you would have to pay a copay. The same could go for any tests that lead to more treatment or follow-up visits.

When can I start using services?

Services covered by your health insurance plan are ready to be used starting the next month after you make your first payment, even before your membership ID card has arrived.

Put a little Joy in your insurance experience.

Joy Olivier Insurance Agency Inc. has been helping Californians find the right health insurance. We love what we do and it shows. Come see why California is switching to Joy.

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Joy Olivier Insurance Agency Inc.
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