Top 20 Questions for Individual California Health Insurance
Understanding the Health Plans
- 1. What's the best (value) plan now
- 2. Difference between Blue Cross and Blue Shield
- 3. Difference between HMO and PPO
- 4. How are Pre-existing conditions handled
- 5. Is my doctor in the list
- 6. Can you break down the PPO plans
- 7. What does deductible mean
- 8. What does max-out-of-pocket mean
- 9. Can the rates change
- 10. Can a child have a plan alone
You can always run your quote here:
Enrolling in a Health Plan
- 1. What is needed to start the process
- 2. How long does it take
- 3. Do I submit payment with the application
- 4. Is there a fee to apply
- 5. Do I need a physical
- 6. How can I expedite this
- 7. Am I locked in for a period of time
- 8. How is payment handled
- 9. Can I change my plan later
- 10. Why should I go with you
What is the best plan (value) now
This whole question has changed with the Affordable Care Act.
Income affects everything now including the plans that are available.
It generally comes down to the Bronze and the Silver level, especially if you are offered the Enhanced Silver plans.
You can run a quote here but it's probably best to call us at 800-320-6269 so we can take into account tax credits that might be available.
More detail here : best Covered California plans
Difference Between Anthem Blue Cross and Blue Shield of California
Anthem Blue Cross and Blue Shield of California are separate, competing carriers that compete in the Individual and Small Group markets within California.
Provider Networks The HMO and PPO networks are pretty comparable between the two and both are genuinely available in all California counties.
You can find roughly 50K doctors and 400 hospital in either company's PPO network.
There will be individual providers that participate in one but not the other so double check with the Online California Doctor Directory
Financial Strength Both carriers are strong and have a long history in the California health insurance market.
This is especially true for the PPO model in the State.
Health Reform will be a big test to many less well run carriers and we expect Anthem and Blue Shield to make it through.
Plans Both companies offer a wide range of competitive plans across the Individual, Small Group, and Medicare supplement markets.
From dealing with the carriers on a daily basis, we feel comfortable recommending either to our clients.
Difference between HMO and PPO
You probably already have a strong feeling about HMO's and PPO's but we'll look at a snap shot of differences.
With a PPO, You will have access to more providers and with a greater degree of freedom. In return, you will share more of the cost when you access these providers.
With an HMO, how you access your care is more structured and you will have to stay within a certain group of providers.
The benefits are standardized now with the ACA plans.
TIP HMO's have become more expensive so compare the annual premium difference with PPO options to make sure you are not paying too much.
How are pre-existing conditions handled
Health is no longer a factor in underwriting due to the ACA law.
There are also no waiting periods for pre-existing conditions.
There are Open Enrollment windows however so it's important to understand how those work.
Is my doctor on the list
You can check for your doctor or hospital below. Make sure you specify HMO or PPO.
Sometimes, doctors are listed under medical group or a billing doctor so if you do not see your doctor on the list, call their office and ask if they EXAMPLE..." participate in the Blue Cross PPO network".
Can you breakdown the PPO's plans
This is a simple breakdown and you should read through the benefit summary for more detail but it helps to simplify the plans.
PPO plans breakdown into three main categories: Office consultation, Prescriptions, and...pretty much everything else (hospital, labs/x-rays, emergency, surgery, etc..)
Most plans offer some type of immediate coverage for the office consultation and generic drugs. Keep in mind that there can be a separate deductible for Brand Name drugs.
The "everything else" is typically subject to the main deductible ($0-$7000 depending on plan).
Once you meet your deductible, you pay a percentage until you reach your max-out-of-pocket.
What does the deductible mean
A deductible is an amount that you will pay first before the plan kicks in.
Keep in mind that you will still get the discounted rate (usually 30-60% off) on covered benefits, in-network even before you meet your deductible.
After the deductible is met, you typically go into a % of the discounted rate.
Some benefits such as brand name descriptions may have their own separate deductible.
What does max-out-of-pocket mean
This basically lets you know how the plan will treat large bills...so called catastrophic or major medical coverage.
Your max-out-of-pocket let's you how much you will pay up to for covered benefits, in-network in a calendar year.
Usually, the max is per person up to two people maximum.
Can the rates change
Rates typically change now on Jan 1st during Open Enrollment for individual and family plans (including Covered Ca) even if you have a mid-year birthday.
Can a child have a plan alone
Yes. With either carrier, you have a single child or multiple siblings on one plan if they are under the age of 18.
What is needed to start the process
The easiest way to apply for Individual and Family plans including Covered California is to call 800-320-6269 and enroll right over the phone.
It takes 5 minutes and will save you hours of headaches.
This way, we can also make sure the information is correct and you are getting the most tax credit available to you.
How long does it take
We generally enroll everyone within 24 hours and a confirmation letter arrives by mail in about 7 business days.
The first invoice generally arrives about 1 week after that confirmation letter.
Find out more about the effective date rules.
Do I submit payment with the application
An invoice will arrive from the carrier with the first month's premium about 2 weeks after enrollment.
We can also take the first payment over the phone for most carriers.
Is there a fee to apply
There is no fee to apply.
Is a physical required
A physical is not required...only the completed application and first months premium.
How can I expedite the processing
Enrolling over the phone and then paying the first month's premium by phone is the quickest approach.
Am I locked in for a period of time
No. The policy can be cancelled or renewed (by payment) month to month.
How is payment handled
Once you have paid the first month (binding) payment, you can then create your online account with the carrier. You can manage billing options there.
Can I change my plan later
You can generally change your plan during Open Enrollment at the end of each year or during Special Enrollment Periods. More info on those here.
You can access the online application here:
Why should I go with Goodacre Insurance Services
We concentrate on health insurance for
California