Individual & Family
Group health
Medicare Supplement


Free Assistance 800-320-6269

California health insurance  -  Health insurance articles for California  -  How to use your health plan

How To Get the Most Out of Your California Health Plan

Your health insurance plans is very costly these days so nothing is more frustrating than when you don't get the full benefit out of it when sickness or injury occurs. It can be quite costly to use your plan incorrectly or not to take full advantage it.

Here are a few quick tips to help you get the most of you California health insurance plan.

Understand the health plan you are purchasing.

People go in the quoting engine and they just want to get it over with. We's not fun. They see a few numbers that sound about right followed by a premium that's in their budget and rush on to the online application. They figure that they're healthy...they won't need it anyway. STOP.

First, find a knowledgeable California health insurance broker (hint at and ask the questions that are most important to you. It's good to research health insurance online but even with the detailed articles on our site, a good agent or broker can really help the process. Half the time, the applicant will go with a less expensive plan after speaking with us, and half the time, more expensive. The important part is that you have the right plan and this will be different for each person.

Interestingly, there are two main camps of incorrect plan choice that we run into.

1. Buying too little health insurance coverage.

With the rate increases year after year, the market is quickly pushed to the lowest hanging fruit...catastrophic plans and even hospital only coverage. Of course these tend to be some of the least expensive plans on the market. The problem is that you could wind up with a $20,000 bill that's not covered. This defeats the purpose of having insurance. There is usually a comprehensive plan that's comparable or slightly higher price-wise.

We can help you find it.

2. Too much health insurance coverage.

 It rarely makes sense to go higher than the low-middle to middle priced plans, especially since you have to be healthy to qualify for coverage anyway. When you look at the premium difference over a year's time, it usually makes sense to save the premium and take the higher deductible. If you have a bad year, it's probably a wash since you're saving on the premium. With an average or good year, you keep the premium difference in your pocket.

The final take away is that you really want to know the kind of plan you are buying. We have dozens of pages that help you to analyze the plans and narrow your options but ultimately a professional agent on the other side of a phone is nearly impossible to beat. can spend the hours studying yourself.

Work within the rules of your California health insurance plan

This can be quite different between PPO and HMO plans so let's look at both.


HMO's by definition are much more structured and you really need to stay within the rules or you can have quite a bit more out of pocket. The key point is always ask first. Some plans let you self refer to specialist but don't assume. Your Primary Care physician is your point of contact for all care. Run any moves by the office first. This can include procedures you want done (MRI, diagnostics, etc); seeing a specialist; and emergency or out of area care.

Your take away is always Authorize before; Ask during; and Notify after. Make sure to also take advantage of low cost preventive check ups and labs. Ask your primary care about Annual check ups, preventative treatments, and other benefits.

Great Guide to Differences in the California Networks


The key point with PPO's is to stay in network and price shop. By definition a PPO plan is a big group discount. The carrier tells the doctors that contract with it on a PPO basis, "We're going to bring a lot of patients your way, but in return, discount your services when they come in". If you go out of this network, you will pay more out of pocket.

Sometimes, much more.

 Another key points that most people don't realize is that you can and should shop health care services on the market within the PPO network. For example, I needed an MRI for an ACL repair and the doctor recommended the local hospital (which happens to be one of the most expensive in the State).

I asked if there was an alternative and the doctor referred me to a competing imaging center. The cost at the hospital would have been $2000 while the imaging center was $800 for the exact same service. As long as the doctor recommends the alternative, check their PPO prices. Now that deductibles and cost sharing are a main component of PPO plans, enrollees need to change their mindset.

Healthcare is one of the few (if not only) market where people do not think to "shop".

This will change significantly going forward as the difference is money in your pocket. The old plans with very rich plans are gone primarily because they promoted a disconnect between the consumer (you) and the actual cost of health care.

Prescription coverage and your California health insurance plan

Brand name medications and their subsequent direct marketing to the consumer have significantly altered the healthcare landscape (and your monthly premium). This will only continue as new and more targeted medications hit the market. They are expensive but also very effective so it's a mixed blessing.

Work with your doctor to see if there is a generic that will work instead of a brand name medication. You will pay much less out of pocket this way with either HMO or PPO's. If your doctor is fine with the alternative, give it a try. Some of the most popular plans on the market only cover generic RX or cover brand RX after a very high deductible (usually $7500).

Generics will probably work for many common situations but there are times when a generic is not available and those are going be expensive drugs most likely.
With these general tips, you should be able to get the most out of your California health insurance plan.

You can run your California Health Plan Quote here 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!


In just 15 minutes:

  • - Get the most tax credit available
  • - Find the best plan for your needs
  • - Enroll right over the phone!

Call 800-320-6269

Our Services are FREE to You!

Need Help
With Existing Account

We can help you:

  • -Get required docs to covered Ca.
  • -Make changes to income and other info
  • -Choose and finalize plan enrollment
  • -Make sure you get right tax credit
  • -Payment/membership issues with carriers

Call to Enroll over the Phone in 15 Minutes

If Your Income
Is In This Range

Current Years Estimate; All those that file together on one 1040:

Single Person: $16k - $47k
2 People $22k - $64k
3 People $27k - $80k
4 People $33k - $97k

Call 800-320-6269
Anthem Blue Cross California
Blue Shield of California under Covered California
Kaiser of California
Health Net of California
and more
Thousands of Californians
Hundreds of California Companies
Thousands of Californians
Hundreds of California Companies

from SC

"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"

from SD

"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

from KV

"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."

from EK

"I thank you very much for the time that you have invested in handling everything

from SR

"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."

from VH

"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"

from SA

"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"

from LM

"You are my new best friend. A HUGE thank you again.

Find out what customers are saying about our services

20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable

We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.

We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.

Call will be Pleasantly Surprised.  800-320-6269

Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit

calhealth website

Our Services are FREE to You is a Goodacre Insurance Services Website

This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.