Individuals and Families
Each insurance carrier has a number of plans with varying degrees of coverage and cost. So, how do you pick the right one?
First, remind yourself of why you're buying coverage - to protect against a catastrophic event or a major claim. Right? The size of the deductible is important, but the key figure is the Maximum Out-of-Pocket (or OOP) which also includes the co-insurance amount you pay after the deductible is met. Some plans have no co-insurance and pay 100% after the deductible is met, while others require you to pay 30%, 40% or even 50%.
We believe a plan with "comprehensive" coverage is essential in a Individual or Family health plan and we have listed those benefits that can protect you from serious financial loss. When reviewing plans, we encourage you to consider ones with these benefits.
We recommend comprehensive coverage. Here is a list of benefits we think are essential:
- Major Medical expenses (surgery, hospital, ER)
- Office Visits
- Lab and x-ray
- Generic and Brand Name Prescription drugs (Just because you don't take Brand Name drugs now, doesn't mean you won't be prescribed an expensive one later.)
- Physical Therapy
- Preventive coverage (by law most all plans now cover extensive preventative care services)
How these benefits come determines the premium. Plans with low deductibles and low out-of-pocket costs, flat copays for prescriptions, office visits and emergency room services are reasons some plans have higher premiums than others (and higher future rate increases).
If you are willing to take on more initial financial risk by choosing plans with a higher deductible and/or without copays, the savings in premium can often outweigh the benefit of more generous plans.
Maternity coverage is another benefit that may or may not be covered in a plan. Please be aware that this is not a benefit you can just add later. You may have to qualify for a plan that includes Maternity and coverage is not guaranteed.
Send us an email if you have questions about a specific plan, or need more assistance in selecting the right plan.
Our quoting system will allow you view up to four plans side by side so you can easily compare benefits and rates.
Uninsurable and Uninsured?
As part of our new healthcare law (Federal Patient Protection and Affordable Care Act), California has implemented a federally-funded program called the California Pre-Existing Condition Insurance Plan (PCIP). The PCIP offers health coverage to medically-uninsurable individuals who live in California.
The program is available for individuals who have not had health coverage in the 6 months prior to applying and is run by the Managed Risk Medical Insurance Board (MRMIB). To learn more about this coverage visit their web site at http://www.pcip.ca.gov/Home/default.aspx.