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Gold Healthcare Exchange Plan Outline of Coverage

October 17, 2014

By Katie Banks+

What Is the Gold Plan?

The Gold plan is one the Affordable Care Act, AKA ObamaCare, plans. The four plans ranked from least expensive monthly premium to most: Bronze, Silver, Gold, and Platinum*. All plans will all offer the same essential benefits, however additional/extended benefits may be offered by different insurance providers. Gold is one of the plans that must be offered by your insurance provider if they choose to offer any of the plans, the other is Silver. Gold offers comprehensive coverage with predictable out-of-pocket expenses (combination of deductible, copayment, and coinsurance).

*There is also catastrophic coverage, if you qualify.

Gold Plan Image

Gold Plan Overview

The following information below is for individual and family members. Click here to learn about how the Gold plan works for Small Business owners.

  • 80/20 split, with you paying 20% for healthcare expenses
  • 2nd highest monthly premium. This is without federal subsidies, Do I Qualify for Federal Subsidies?
  • Either no or a low deductible
Benefits Gold Health Plan*
Deductible $0
Preventive $0
Doctor’s Office Visits $30
Specialist $50
Generic Rx $15
Brand RX $50
Lab Testing $35
X-ray $50
Maternity $600 per day HMO**/20% PPO
Out-patient Surgery $600 HMO/20% PPO
Hospital Stay $600 per day HMO**/20% PPO
ER Visit $250
Urgent Care $60
Out-of-Pocket Max $6,350/$12,700 (ind/fam)

**Up to 5 days in the hospital

*The chart above is for California. To learn what insurers cover in your state get a Healthcare Exchange quote.

Is there only one Gold Plan offered?

There may be multiple plans within states. Specific plans will be determined by state leaders and insurance providers.

How Does the Gold Health Plan Compare to the Other New Plans?

Gold will have the 2nd highest monthly premiums, but Gold plan members, due to the 20% co-share, will have lower cost-sharing expenses than a plan with a lower monthly premium. Click here to compare Bronze, Silver, Gold and Platinum health plans side-by-side.

Over 65 and ObamaCare

For seniors over 65, ObamaCare does not work the same. Click here to learn more about the Health Care Exchange and Senior Options.

For any questions or assistance in applying during the open enrollment period: November 15, 2014 to February 15, 2015,  please contact Medicoverage. If you’re ready to apply click here to get a Healthcare Exchange application.


The next open enrollment for new health coverage begins October 15, 2015. Applications must be submitted before December 7, 2015 to start a plan in 2016. If you are looking to get covered in 2015 you still have a few options. See link below:

Click here to learn how to get covered in 2015 if you missed the Obamacare 2/15 deadline.

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