California health insurance - Individual and Family health - Key factors in your health plan choice

Key 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.