California health
insurance
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Individual and Family health
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Key factors in your health plan choiceKey Factors in Choosing a
California Individual Health Plan
When you run your instant California health
quote, expect to see dozens of plans come up
with rates and benefits.
This number has actually dropped over the
last 18 months as plans have been pared by the
major carriers but it's still overwhelming. The
plans will usually reference the main deductible
but that does little to help orient a California
health insurance shopper.
We've been doing this (health insurance, that
is) for decades now so we can look at the plan
choices and quickly narrow down the options.
There really are only a few key factors to focus
on when choosing your plan so let's jump right
into our cheat sheet to help guide you to a
better decision.
First, scratch HMO health plans in California
right off your list (if it was there to begin
with). On the individual and family market,
their rates have skyrocketed to where they make
no sense at all.
HMO's for group insurance can still make
sense but it's almost out of the question for
individuals. You'll see them quoted either way
but you can save time by looking at the PPO's.
Next, notice that the carriers now have
"Metallic Levels" of plans.
Essentially plans that all behave the same
way but with different numbers....deductible,
out of pocket, brand RX coverage, and of
course...monthly premium. Notice that we left
out office visit copay. Why? The most
competitive plans these days offer you a certain
number of office copays up front (usually
between 2 and 4 per family member per year).
People tend to fixate on the office copay
amount but this is increasingly less important
to your plan choice.
Preventative benefits will be covered at 100%
on all the plans for covered benefits,
in-network so we're talking other office visits.
Office copays have become less of a focus in
choosing your plans so what is important?
Of the numbers in your quote, look at the
deductible and max as a package deal.
This means, if I get a $20K bill, when do I
stop paying all together? When does the plan go
100% to the carrier for covered benefits,
in-network? This is the important number due to
today's health care environment. Think of you
own history. Most people will either be way
below their deductible (say $200-$800 in a year)
or way over. One simple surgery can quickly run
$10-20K even on an out-patient basis. That's the
reality we're trying to insure against. We want
to know when the plan will go 100% for that big
bill. We have to look at the deductible and max
out of pocket to get this total exposure. Just a
head's up...some carriers will show the max
including the deductible while others will show
the max in addition to the deductible.
We described more on this with a full article
explaining the deductible versus OOP
differences.
That's the number you really want to focus on.
The exposure for the big ticket item contrasted
with the annual (not monthly) premium. For
example, if you can drop your annual premium by
$1000 a year simply by increasing your
deductible by $1000 or even $1500, that's a
pretty smart downgrade. That also helps you
compare apples and oranges (plan designs by
different carriers). It's the ultimate equalizer
when shopping individual California health
insurance.
Finally, we need to look at medication.
Some plans cover only generic while
others cover generic and brand (after brand
deductible). This becomes a personal decision.
On one hand, the brand RX plans don't really
help much unless you get very large RX expenses
since they're more expensive and they have a
separate deductible. That being said, the point
of insurance is to protect against the rare but
very expensive potential bill. We could argue
this either way.
Ultimately, look at the premium difference
between similar (if not identical plans) with
generic and brand options. Does the difference
justify a move one way or the other?
We can help you with this comparison of
course.
You can use these as benchmarks when you run
your individual California health insurance
quote. We're happy to walk through these with
you in detail.
You can run your
California
health exchange plan quote to view rates and plans side by side from the major carriers...Free.
Again, there is absolutely no
cost to you for our services. Call 800-320-6269 Today!