Understand Your Health Plan & Unlock YOUR Price
Explore patient-readable coverage guides for 9 major California payers and public programs (Covered California, Medi-Cal, and Medicare), compare 2026 standard copays side-by-side, or add your insurance card to unlock Tier 2: Your Price across every procedure and CareHub condition page.
Shows published self-pay cash prices, 2026 CMS Medicare fee schedule baselines, and all-payer negotiated ranges.
Filters every procedure and CareHub page to your specific insurer's contracted hospital rates, labeled “Your Price.”
Parkinson's Disease Insurance, Medicare & Long-Term Care Guide
Plain-English guide to what Medicare covers for Deep Brain Stimulation (CMS NCD 160.24), DaTscan (CPT 78803 + A9584), and LSVT BIG / LSVT LOUD therapy (KX modifier rules) — plus Original Medicare + Medigap vs. Medicare Advantage trade-offs and California Medi-Cal IHSS ($0 asset limit).
Explore Payers, Networks & Public Programs (9 Guides)
Click any insurer or public program to see what it covers for common services, which Bay Area hospitals are in-network, referral rules, and contracted hospital rates across all 18 shoppable procedures.
Anthem Blue Cross of California
Broad Prudent Buyer PPO, California Care HMO, Covered California Pathway EPO, and Medi-Cal Partner networks across all 9 Bay Area counties.
Blue Shield of California
Nonprofit California health plan offering Shield Spectrum PPO (the only statewide PPO on Covered California) and Trio ACO HMO.
Kaiser Permanente Northern California
Integrated closed-panel health system combining insurance coverage, Permanente Medical Group physicians, and 21 Northern California medical centers.
UnitedHealthcare (UHC)
National employer-sponsored Choice Plus PPO, Navigate/Select EPO, SignatureValue Alliance HMO (Canopy Health), and AARP Medicare Advantage.
Aetna (CVS Health)
Open Access Managed Choice POS/PPO, Elect Choice EPO, Basic HMO, and Student Health plans widely used by Bay Area employers and universities.
Cigna Healthcare
Open Access Plus (OAP) PPO and LocalPlus networks serving multi-state employers and Bay Area corporate teams.
Health Net of California (Ambetter / Centene)
California health plan offering Ambetter HMO/PPO on Covered California, SmartCare employer plans, and Medi-Cal managed care partnerships.
California Medi-Cal & Bay Area County Managed Care Plans
Comprehensive $0-cost healthcare coverage for income-eligible California adults (≤138% FPL), pregnant individuals (≤213% FPL / 322% MCAP), children (≤266% FPL), seniors, and persons with disabilities.
Medicare (Original Part A/B) & Bay Area Medicare Advantage (Part C)
Federal benchmark coverage setting the 2026 OPPS, MPFS, and CLFS baseline rates for every procedure in the OpenPHR catalogue, plus contracted Medicare Advantage HMO/PPO plans.
What Each Plan Tier Covers for Common Services (2026 Standard Copays)
California standardizes benefit designs across Marketplace metal tiers so every insurer (Anthem, Blue Shield, Kaiser, Health Net) charges the exact same copays for the same metal tier. Compare Medi-Cal, Enhanced Silver CSR, Gold, Silver, Bronze, and Original Medicare side-by-side:
| Plan Tier / Program | Annual Deductible | Out-of-Pocket Max | Primary Care / Specialist | Routine Labs & X-Ray | Advanced MRI / CT Scan | Emergency Room |
|---|---|---|---|---|---|---|
Medi-Cal (California Medicaid) Adults ≤138% FPL • Pregnant ≤213% FPL • Children ≤266% FPL | $0 | $0 | PCP: $0 Spec: $0 | Labs: $0 X-Ray: $0 | $0 (with prior authorization) | $0 |
Enhanced Silver 94 (CSR) Covered CA Household Income 138%–150% FPL | $0 Medical / $0 Rx | $1,250 individual | PCP: $5 copay Spec: $8 copay | Labs: $8 copay X-Ray: $8 copay | $50 copay | $50 copay |
Enhanced Silver 87 (CSR) Covered CA Household Income 150%–200% FPL | $0 Medical / $0 Rx | $3,000 individual | PCP: $15 copay Spec: $25 copay | Labs: $20 copay X-Ray: $40 copay | $100 copay | $150 copay |
Platinum 90 Marketplace & Employer Plans (Highest Premium, Lowest Copays) | $0 Medical / $0 Rx | $4,500 individual | PCP: $15 copay Spec: $30 copay | Labs: $15 copay X-Ray: $30 copay | $75 copay (or 10% coinsurance) | $150 copay |
Gold 80 Marketplace & Employer Plans ($0 Medical Deductible) | $0 Medical / $0 Rx | $8,700 individual | PCP: $35 copay Spec: $65 copay | Labs: $40 copay X-Ray: $75 copay | $150 copay (or 20% coinsurance) | $350 copay |
Silver 70 (Benchmark) Standard Marketplace Benchmark Plan (>200% FPL) | $5,400 (Applies to Inpatient/Surgery only; $0 for Outpatient Visits/Labs/Imaging) | $9,100 individual | PCP: $50 copay (deductible waived) Spec: $90 copay (deductible waived) | Labs: $50 copay (deductible waived) X-Ray: $90 copay (deductible waived) | $325 copay (deductible waived) | $450 copay |
Bronze 60 / HDHP-HSA Lowest Monthly Premium; High Deductible Before Most Coverage Starts | $6,300 Medical / $500 Rx | $9,100 individual | PCP: $60 copay (first 3 visits not subject to deductible) Spec: $95 copay (after deductible) | Labs: $40 copay (deductible waived) X-Ray: 40% coinsurance after deductible (you pay full negotiated hospital rate until deductible met) | 40% coinsurance after deductible (you pay full negotiated hospital rate until deductible met) | 40% coinsurance after deductible |
Original Medicare (Part A + Part B) Adults 65+ or Qualifying Disability / ESRD / ALS | $257/yr Part B deductible • $1,676/benefit period Part A inpatient | No cap unless paired with Medigap / Supplemental policy | PCP: 20% of Medicare-approved amount after $257 deductible Spec: 20% of Medicare-approved amount after $257 deductible | Labs: $0 copay / $0 deductible for covered clinical diagnostic lab panels (CLFS) X-Ray: 20% coinsurance of CMS OPPS/MPFS rate | 20% coinsurance of CMS OPPS/MPFS rate (~$68 coinsurance for hospital Brain MRI) | 20% of Medicare-approved amount |
Personalize Hospital Prices with Your Insurance
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Your Estimated Price with Anthem Blue Cross
Estimate from published rates — not a quote. Your deductible, coinsurance, and copay depend on your specific plan benefits.