Most plan design changes are modest, but several 2027 maximum out-of-pocket limits rise sharply—especially for Bronze, Silver 70, Silver 73, Silver 87, and Silver 94 plans.
Covered California’s standard benefit designs will change in 2027. Many deductibles and copays remain stable or increase only modestly, but maximum out-of-pocket limits are the major story.
Pharmacy Deductibles Remain Unchanged
For 2027, pharmacy deductibles stay the same across the Covered California standard plan designs. A pharmacy deductible is the amount a member pays for covered prescriptions at a retail or mail-order pharmacy before the plan’s copays or coinsurance begin. Gold and Platinum plans continue to have no pharmacy deductible.
Medical Deductible Changes for 2027
The figures below apply to an individual; family amounts are double the individual amount. Once the family deductible is met (which also applies to the MOOP) all the other members of the household have met the deductible.
- Bronze 60: The medical deductible does not change at $5,800.
- Bronze 60 High-Deductible Health Plan: The deductible, which also serves as the maximum out-of-pocket amount, increases from $7,200 to $7,800 – 8%.
- Silver 70, Silver 73, and Silver 87: Medical deductibles decrease. Silver 70 and 73: $4,700, Silver 87: $1,100.
- Silver 94: A new $200 medical deductible applies in 2027.
- Gold and Platinum: These plans continue to have no medical deductible.
- Minimum Coverage: The deductible and maximum out-of-pocket amount increase from $10,600 to $12,000 – 13%.
On the Silver plans, the medical deductible generally applies only when a member is hospitalized or admitted to a skilled nursing facility. Routine office visits and many other services continue to use copays or coinsurance without first requiring the medical deductible to be met.
The Biggest Change: Higher Maximum Out-of-Pocket Limits
The maximum out-of-pocket limit is the most a member is responsible for paying during the year for covered in-network services and prescriptions. It includes applicable deductibles, copays, and coinsurance. After the limit is reached, the health plan pays for covered in-network care for the rest of the year.
- Bronze 60: $9,800 to $11,650, an increase of about 19%.
- Bronze 60 High-Deductible Health Plan: $7,200 to $7,800, an increase of about 8%.
- Silver 70: Increases to $11,650, about 19%.
- Silver 73: $8,100 to $9,600, an increase of about 19%.
- Silver 87: $3,350 to $4,000, an increase of about 19%.
- Silver 94: $1,400 to $3,000, an increase of about 114%.
- Gold: $9,200 to $9,600, an increase of about 4%.
- Platinum: $5,000 to $5,500, an increase of 10%.
- Minimum Coverage: $10,600 to $12,000, an increase of about 13%.
The Silver 94 increase is particularly important because this plan is offered to people with lower household incomes. A major hospitalization or surgery could therefore create a substantially larger financial burden in 2027.
Copay and Coinsurance Changes
Most benefit copays rise modestly, although Platinum plans see some of the larger increases.
- Primary care: The Platinum copay increases from $15 to $20.
- Urgent care: The Platinum copay increases from $15 to $20.
- Specialist visits: Copays increase by about $5 on Bronze, Silver, and Gold plans. The Platinum specialist copay rises from $30 to $45.
- Emergency room facility: Most plans remain stable, while the Platinum copay increases from $175 to $225.
- Laboratory tests: Most plans remain stable; Platinum increases by $5.
- X-rays and diagnostics: Gold and Platinum copays increase by $5.
- Advanced imaging: Gold increases from a $75 copay to $125, or 25% coinsurance, depending on the plan design. Platinum increases to a $90 copay or 15% coinsurance.
Prescription Drug Copays
Copays for generic, preferred brand, and non-preferred drugs generally increase by $1 to $5 for a 30-day supply. These are relatively modest changes, especially given the role prescription drugs play in overall health care spending.
Enhanced Silver Plan Changes
Members eligible for enhanced Silver plans should pay particular attention to specialist and prescription costs.
- Silver 73 specialist visit: Increases from $90 to $100.
- Silver 87 specialist visit: Increases by $5 to $30.
- Silver 87 laboratory test: Increases from $30 to $35.
- Generic drugs: Most enhanced Silver copays increase by approximately $1 to $2.
- Non-preferred drugs: Silver 73 increases by $10, while Silver 87 increases by $5.
What Consumers Should Review
Covered California appears to have kept many routine copays relatively stable while shifting more potential cost to members through higher maximum out-of-pocket limits. Before renewing or changing plans for 2027, compare:
- The medical and pharmacy deductibles
- The maximum out-of-pocket limit
- Copays for primary care, specialists, urgent care, and emergency services
- Coinsurance for outpatient surgery and advanced imaging
- Your prescription drugs and their formulary tiers
The Platinum plan has several notable copay and coinsurance increases, while Silver 94 has the most dramatic increase in maximum out-of-pocket exposure. Even so, Silver 94 remains a strong plan design for eligible consumers because its actuarial value is higher than that of a Platinum 90 plan.
YouTube video on 2027 plan changes.
