Gold 80 HMO

Kaiser Permanente Gold 80 HMO is an individual and family health insurance plan listed in Kaiser Permanente’s official plan documents for eligible service areas. The Gold metal tier generally balances monthly premiums and out-of-pocket costs, sitting between Silver and Platinum plans in the ACA metal-tier structure. Members receive covered care through the plan’s HMO network and must follow applicable service-area, provider and referral rules. Benefits can include preventive care, outpatient services, hospital care, prescription drugs, mental health services and maternity care as defined by the selected policy. Exact deductibles, copayments, coinsurance, prescription benefits and out-of-pocket limits depend on the applicable plan documents.

Gold 80 HMO may suit individuals and families who want a middle ground between monthly premium costs and expenses when receiving covered medical care. Gold plans have an average actuarial value of approximately 80% for covered essential health benefits across a standard population; this does not mean the insurer pays 80% of every member’s bill. The actual amount a member pays depends on the covered service, network, deductible, copayment, coinsurance and annual out-of-pocket maximum. As an HMO, routine care generally follows the plan’s participating provider system and applicable referral rules. Compare the local Summary of Benefits and Coverage with other available tiers before enrolling.