2027 Covered California Benefits and Costs

A deductible does not mean you must pay the full price for every doctor visit. Covered California’s September 2026 benefits table for 2027 lists many services with copays that apply before you meet your deductible—including primary care visits, urgent care, and generic prescriptions in the metal-tier plans shown below.

When comparing plans, look beyond the monthly premium. Your deductible, prescription costs, visit copays, and annual out-of-pocket maximum all affect what you may spend when you use your coverage.

2027 deductibles and out-of-pocket limits

Each pair below shows the individual amount first and the family amount second. These are benefit cost-sharing amounts, not monthly premiums.

Source: Covered California, 2027 Patient-Centered Benefit Designs and Medical Cost Shares, September 2026. “None” corresponds to “N/A” in the source deductible rows for these plans.

What these amounts mean

A deductible is the amount you pay for services subject to that deductible before the plan begins sharing those costs. Some benefits have copays that apply before the deductible. A copay is a fixed dollar amount; coinsurance is a percentage of the allowed cost.

The out-of-pocket maximum limits what you pay for covered services that count toward that limit during the year. Monthly premiums and charges such as noncovered care do not count toward it. Check the plan documents for network rules and other exclusions.

Gold and Platinum show no medical or pharmacy deductible in this table. That does not make every service free: visit copays and other cost sharing still apply.

What common services cost in 2027

All seven plans below list a $0 preventive care visit. The table also lists these patient costs for common services. Prescription amounts are for a 30-day supply.

*Bronze’s $100 specialist copay applies to the first three specialist visits. After those visits, the chart says you pay the full cost until the medical deductible is met. Review the plan’s Evidence of Coverage for the complete rules.

The emergency room column shows the facility charge only; it is not a quote for the total cost of an emergency visit. Other services may have separate cost sharing.

Seeing a doctor before meeting the deductible

The 2027 Bronze design lists a $60 primary care visit and a $60 urgent care visit that are not subject to the medical deductible. The specialist exception above is different. Bronze emergency room facility care, X-rays, and imaging are listed at 40% coinsurance after the medical deductible is met.

This distinction matters when you compare plans. A plan with a higher deductible can still provide access to certain services for a set copay before you meet it. Check the specific service instead of assuming that one deductible rule applies to everything.

Prescription costs depend on the drug tier

The generic copays in the table are not subject to the pharmacy deductible. Other prescription tiers work differently. For Bronze, tiers 2 through 4 are listed at 40% coinsurance, up to $500 per prescription, after the drug deductible is met.

For standard Silver, the preferred-drug copay is $65 after the pharmacy deductible. Silver 73 lists $55, and Silver 87 lists $30, also after that deductible. Silver 94 lists $10 with no pharmacy deductible. Before enrolling, check your medications against the plan’s drug list and confirm any coverage requirements.

Why Enhanced Silver deserves a close look

Eligible applicants may qualify for Silver 73, Silver 87, or Silver 94 with reduced cost sharing. The differences can be substantial: the individual medical deductible is $4,700 for standard Silver, $1,100 for Silver 87, and $200 for Silver 94. The corresponding individual out-of-pocket maximums are $11,650, $4,000, and $3,000.

Eligibility depends on household income and other factors. Some applicants may qualify for Medi-Cal instead. A benefits chart shows what each design offers; it does not establish which coverage you qualify for.

Related reading: 2027 Covered California income limits and subsidies

Questions to ask before choosing a plan

• Are your doctors, hospitals, and preferred pharmacies in the plan’s network?

• Are your medications covered, and what tier and cost-sharing rules apply?

• What would you pay for the appointments and services you expect to use?

• How does the monthly premium compare with the deductible and annual spending limit?

• Do you qualify for premium assistance or an Enhanced Silver plan?

Frequently asked questions

Does a no-deductible plan cover everything at no cost?

No. Gold and Platinum have no deductible in this chart, but they still have copays and other cost sharing. For example, a Gold primary care visit is $40 and a Platinum primary care visit is $20.

Is Silver 94 available to everyone?

No. Silver 94 is an Enhanced Silver option for eligible applicants. The benefit amounts alone do not determine eligibility; household and application information must be reviewed.

What about Minimum Coverage plans?

The source chart lists a $12,000 individual and $24,000 family out-of-pocket maximum for Minimum Coverage. Most services require paying the full cost until that limit is met, with exceptions including preventive care and the first three qualifying nonpreventive visits. Do not interpret the chart’s “N/A” deductible entry as meaning routine care is broadly covered without substantial cost sharing.

Find the Right 2027 Plan for You

Get help comparing your doctors, prescriptions, and plan costs with a Covered California Certified Insurance Agent.

CALL 800-771-7653

Click here to schedule a phone appointment

Covered California Certified Agent is an independent certified insurance agency, not the official Covered California marketplace. We are not affiliated with CoveredCA.com or the State of California.

Benefit amounts are based on Covered California’s September 2026 table for the 2027 plan year. Actual coverage, networks, exclusions, and any approved benefit variations are governed by the selected plan’s Summary of Benefits and Coverage and Evidence of Coverage.