California health insurance - California health coverage basics - Current individual health plans

The Current California Individual Health Insurance Planscape

IMPORTANT UPDATE: The new ACA plans are standardized by law and different from pre-ACA plans below. You can quote the new plans here.

We haven't seen such a rate of change in the individual and family health insurance market since....well ever.

The last 12-18 months have seen the entire available suite of plans drop in half with multiple carriers completely switching out their plans.

It's time to take another look at what's available now before the next, even bigger change takes place at the beginning of 2014 with the mandated Health Reform plans. We'll also make an educated guess as to what that might look like.

Let's take a look at the current market and see what makes sense. We don't expect too many changes since it will all change Jan 1st. Let's jump in...what makes sense right now?
Right now, you have 4 major California carriers that have any strength in the market along these lines: benefits options, pricing, network, and ease of dealing with. We'll assume those are the big four on everyone's mine...especially pricing.

The carriers are Kaiser, Blue Shield of California, Anthem Blue Cross, and Health Net.

Aetna is leaving the individual market and no longer accepting applications. We'll focus on these four since they have best staying power and more likely to make it past the Health Reform gauntlet. A few key points to set the stage.

HMO versus PPO

HMO's are dead.

They are way too expensive on the California individual health insurance market. Unless someone else is paying your premium and you don't mind have more narrow networks and structured benefits, look at PPO or HSA.

Maternity is covered on all plans effective July 1st, 2012. Preventative benefits are also covered on all plans so we scratch that off our list as well. If you're on an older plan, it definitely makes sense to see what's available on the market. Which plans then are priced well now?
There are a few suites out of the dozens of plans that make sense when you run your Individual health quote. We'll break it down by Carrier. Keep in mind that age, area, and family make-up can make certain plans more competitive (just due to how claims have come down) than for other ages, areas, and make-ups.

Mid-Level Benefits.

When running a price quote, we usually take a quick look at Anthem $3500 Smart Sense both Generic RX and Upgrade RX (identical pricing except for medication coverage). For mid to low level pricing, this plan is hard to beat. You can always go up in benefits but look at the annualized premium difference. In most situations it's hard to justify the extra premium for the received benefit. It's true going the other way (to less rich benefits) except for one exception which we'll discuss next in the Catastrophic section. Shield has a comparable suite of plans called the Shield Wise plans. Here, just compare the deductibles and premium between the two and this is a solid approach.
Catastrophic Coverage. If cost is the driving factor (and let's face it...it is for most people and rightly so with all the increases over a decade), we look at either Anthem's Clear Protection $3300 or Health Net's Advantage 3500 PPO plan which are priced very well. There's a real argument to be made for just using California health insurance to cover the big bill and saving on the premium side. These plans fit that bill.
HSA Plan. Finally, the HSA plans are not priced as well as they used to be but if you fully fund the separate HSA account, the net savings can make them competitive. They also have very low max out of pockets for the big bill although smaller bills will be subject to the main deductible (outside of preventative). For HSA plans, Shield's Savings Plans have been the best option.
Kaiser Plan. Kaiser is almost a world unto itself. You either want Kaiser or you don't and within their suite of plans, the higher deductible plans make more sense as is the trend throughout the broader market.
The net net...it's hard to justify going richer than the Clear Protection $3300 with Anthem or the Advantage $3500 with Health Net. This is especially true since all these plans will go away Jan 1st, 2014 (Health Reform plans) and you will be able to quote those with and without Subsidies right through calhealth.net We notify our clients and visitors of important Reform updates to help them navigate the coming changes.