You can quote all the plans off-exchange or through Covered California right here.
If that was the end of it, this would be a pretty short article.
The issue is that health insurance is very complicated and even more so with the tax credit and income piece now.
Our goal is to quickly give you the tools and inside scoop on the health plans so you can actually read the quote and feel confident in your decision!
We'll break out to other articles if you need more information but consider this a cheat sheet to running and reading your California individual or family quote.
Let's see if we can bring that number down.
Here are the topics we'll cover while running the quote:
Let's get started.
You can always run your Covered Ca quote here:
This is the biggest issue, especially with the tax credit calculation.
Here's the info we need for a correct quote:
The last piece is the hardest part.
We have a whole breakout of questions and walkthroughs on that point.
Basically, we're trying to estimate our AGI on the 1040 tax form for the FOLLOWING year.
So...for example...if we're looking for coverage in 2021, we would estimate our AGI on the April 2022 tax form.
Some people will add back into this the following if not already included:
We're happy to help with this piece as it's consistently the biggest issue.
We want to enter the full year's income.
As for family members, it's everyone that will be on the 1040 tax form even if not enrolling.
There's a way to select which family members are actually going to be quoted and we can help with that as well.
In fact, with dates of birth, zip code, and income estimate, we're happy to run a full quote and point out any tips or advantages we see.
We have been enrolled 1000's of people since the ACA started in 2014 and we have 20+ experience with California health insurance.
Check our Google reviews.
Again, we go deeper into how the tax credit, income, and enhanced benefits work here.
Once this info is entered, you'll see a range of different plans and rates.
Let's figure out what's available and how to read it.
The plans will generally be listed in increasing monthly premiums.
There are 4 main plan levels:
We explain how to compare the plans below but our PlanFinder tool is really the go-to option through this maze.
Of course, we're happy to walk through and there's no cost for our assistance
You'll see a filter box on the left which allows you to filter plans according to:
If there's a particular carrier or network you need for your doctor, this helps narrow the field.
Keep in mind that the plans are the same but the rates can be very different from carrier to carrier.
This is usually because the networks are really different.
That and HMO versus PPO.
Under each plan, you'll have access to the brochure, network listing, and more.
The network listings from the carriers are pretty good but it makes sense to check with your doctor to see what "Covered California" plans they accept.
This is the name for all the new network plans be it on or off-exchange.
Any tax credit due to household size and income will automatically be deducted from the rates shown.
You can play with the income at the top to see the impact on resulting costs.
The only advantage for off-exchange is that are different versions of the Silver plan which can be cheaper IF we're not getting a tax credit.
You can run quotes for either on or off-exchange. With any confusion on which one, check with us. We can quickly size up whether off-exchange makes any sense.
So….you have all this info in front of you….now what?
Our plan finder tool walks through this process step by step but some key takeaways from helping 10's of thousands of Californians find the right plan.
We'll break it down into these basic categories:
Let's walk through those.
Am I getting an Enhanced Silver plan based on income?
The "flavor" of the silver plan you are offered depends on income.
There are four main levels:
The rate is the same (outside of changes in tax credit)
If you're eligible for the Silver 87 or 94, that's hard to beat. You definitely don't want to go up to the Gold or Platinum.
The bronze might still make sense if you just want the lowest-priced plan available.
It depends on the difference in cost between the two which brings us to
the next section.
In a given plan (say Silver) within a carrier/plan type (say Blue Shield PPO), what's the annual difference in cost?
We're not looking at the enhanced silver effects...just differences in cost.
Basically, each level is $200/monthly more and that's about $2500 annually.
This "difference" usually is based on age...as we get older, there's a bigger and bigger difference in cost.
On average, the higher the difference between levels, the more it makes sense to go down in plan type.
For example with the above setup..the difference between bronze and gold is about $5000/annually.
That's almost the entire deductible whether you use the plan or not!
Again, we're happy to help you quickly size up the options and find the best value.
Premium differences are only part of the equation...our known healthcare costs also factor in.
Let's go there!
As we mentioned above, if you're in your 50's or 60's, it might not make sense to go richer regardless of health care costs.
We still need to look at what's expected.
Some of the biggest considerations:
Prescriptions are subject to the main deductible with the bronze plans.
If you have lots of RX and/or office visits, the silver plan might be the lowest level to consider since those are carved out.
Again, we can help with this.
Then there's the max out of pocket...our expected exposure in a year for covered benefits (in-network).
If we get a 100K bill, when does the plan take over?
That's the max.
Interestingly, the max is roughly the same (high) for the bronze, silver (standard), and gold plan.
The platinum plan drops the max but at what cost annually?
If you're getting the Silver 87 or 94 based on income, they have the best exposure for large bills and that can be a deciding factor.
That's why the income estimate is so important and we can help you with that (no cost as certified Covered Ca agents).
Some people will be just on the edge of SIlver 87, not understand the time-frame or elements of income to include, and miss out on a HUGE boost in benefits for the very same cost.
Again, check out the PlanFInder.
What about carriers?
Once we have a general sense of the plan level (say, silver 87), then how we compare THOSE plans?
The benefits are standardized so they will all have the same general plan levels (deductible, etc).
It then becomes a question of the network - the doctors and hospitals you have access to.
There can be very big differences in network size and quality.
The network-style can also affect pricing significantly.
HMO. PPO. EPO. We have a complete breakdown of networks here but the quick skinny:
Make sure to say "Covered California" (even if off-exchange) since there are different networks for individual/family plans.
Again...plan selection is the toughest part of this.
What if we find a plan we like?
There's an apply button right next to each plan.
This works well for off-exchange applications.
For on exchange, we actually created a simplified online application
We then go through and scrub the app for anything that might cause an issue or if we something that you're not taking advantage of (close to enhanced silver plan, etc).
We get these processed and confirm enrollment generally in 24 hours.
We're also able to help throughout the year with questions, changes, and more!
Again, check out our Google reviews here to see.
In the meantime, let us know how we can help!