Health insurance is complicated but very necessary. Let A+ Insurance Service help you choose the best health insurance plan for your needs and budget
The things to look for when choosing a health plan include:
HMO or PPO or EPO – The types of plans differ in price and flexibility. Generally, less expensive, an HMO (or health maintenance organization) requires that you use a primary care physician (PCP) to coordinate your care and refer you to specialist or order tests from providers within the HMO’s network. There is no out-of-network coverage, except in the case of an emergency. The pricier option, a PPO (or preferred provider organization), features a network of “preferred” providers in the state. You do not need referrals to see a specialist. Your portion of the bill will be considerably less if you see a doctor in the preferred network, but a PPO generally covers a portion of the cost for seeing an out-of-network provider. Priced in between, an EPO (or exclusive provider network) offers more flexibility than an HMO in that you do not need a referral to see specialist in the plan’s network. However, there is no out-of-network coverage, except in the case of an emergency.
A plan’s network and whether your doctor or preferred hospital participates – A doctor’s office may tell you that they contract with Blue Shield, but that does not mean your Blue Shield plan includes them. Insurance companies have networks of doctors, hospitals and other providers with which they contract and establish rates. Statewide, however, the cost for medical care differs dramatically between doctors and hospitals besides HMO versus PPO. So, health plans develop smaller or medium-sized networks that have lower premiums than their full ones. The smaller network may only include less expensive doctors, hospitals or labs. However, if large parts of the state, a smaller network may include the local hospital or doctor group you prefer, but not include big name, more-pricey facilities like Cedars-Sinai Medical Center or Stanford Hospital that are further away. It is important to see which providers are in the plan you are considering to make sure it meets your needs.
A lower premium or lower copay? – Do not choose a plan based on price; consider your needs. Do you rarely visit a doctor or see someone regularly? What about your prescription needs? Since the ACA, health plans are offers in four metal categories: Platinum, Gold, Silver and Bronze. These are based on the “actuarial value” or percentage of costs the plan covers versus the insured. A Platinum plan costs the most each month, but has no deductibles and the lowest copayments. The insurance company pays 90 of medical expenses on Platinum plan. Conversely, a Bronze plan will cost considerably less per month in premium, but have higher deductibles and out-of-pocket costs. Bronze plans cover an estimated 60 percent of an insured medical expenses.
Where to purchase coverage? There are 3 different ways to purchase policies for individuals and families in California, based on annual household income. Our team at A+ Insurance can help you :
- A plan purchased direct from the company (aka off-exchange or direct)
- A plan purchased through our state exchange, Covered CA, possibly with a subsidy (aka on-exchange)
- Medi-Cal (CA’s Medicaid program that offers free or low-cost health coverage for those with limited income)
Individual insurance policies nowadays are based on calendar year. The annual enrollment period (November to January) permits anyone make changes. Throughout the rest of the year, you can make changes within 60 days of a Qualifying Life Event (or QLE). Unsure of what a QLE is? Check the image below!
If you missed Open Enrollment, check out our Short Term options.
If you’re eligible and ready to enroll, please click here for a quote OR call us for assistance!