The Current (12/20/11)
California Individual Health
Insurance Planscape
The California health insurance
market is always changing and now
more than ever. Some plans fall out
of favor while others mark
themselves as good values. One
thing is for certain the costs keep
rising will only continue going
forward into 2014 as we'll describe
in a separate article. For now,
let's focus on current trends and
plans that stand out as the best
values on the California health
insurance market.
First, let's tackle maternity
coverage. You can skip this
paragraph if maternity is definitely
not needed although that may all
change July 1st, 2012. We've lost
most of our maternity plans on the
market and out of the few remaining
with the major California health
carriers, there's really only one
that make sense. If maternity is
even out there in the ether as a
possiblity, look at the Shield
Spectrum $5000 or $5500...whichever
is less expensive as they're
virtually identical in core
benefits. The other plans are
generally much more expensive
(sometimes double the cost) for
comparable coverage. Back to our
July 1st milestone, the State
legislature has passed a bill which
will mandate maternity coverage on
every California health plan. We're
not sure if this will apply to
existing plans and/or grandfathered
(under health reform statute) plans
but we should have that info soon.
This will likely result in a 10-20%
increase on premium on all those
plans or big changes in the benefits
(deductibles/max out of pocket) to
offset what is a very expensive
health care cost resulting from
facility based care associated with
maternity. We'll keep you posted.
One note...if you become pregnant or
your health changes on a plan
without maternity, it can be
impossible to change to a plan with
maternity.
For non-maternity plans, there are
two main paths that are generally
dictated by age. If you are in your
50's and 60's, more of a
catastrophic type plan makes sense.
For this, you would look at Anthem's
Clear Protection plans ($1000,
$3300, or $5000) deductible where
the max out of pocket includes the
deductible. They do not cover brand
name RX but the pricing is the best
on the market and in those higher
age-bands, the savings can more than
offset going with a richer plan over
a annualized period of time. You
can go richer (mainly to get brand
RX and lower deductible) but it's
hard to make the case. Self-insure
the difference and save the money on
premium.
For younger people...essentially
below 50's on average, look at
either the Vital Shield Plus plans
with Blue Shieid or the Smart Sense
plans with Blue Cross. They're very
similar and both suite of plans have
a generic RX only option or a
comprehensive RX option. Beyond
that, you're choosing a deductible
amount and of course a monthly
premium amount. For some ages/zip
codes, Shield will be cheaper and
for others, Cross will be cheaper.
These plans generally offer the best
value to premium comparison on the
market versus what Aetna, Health Net
and other carriers offer. Of
course, were happy to walk through
your situation or the plans in
question to really understand how
they work.
There are also HSA plans which add a
tax benefit but also require
separate (from the monthly premium)
funding into the HSA account. These
use to be the best priced plans on
the market but are not as
competitive against the plans
mentioned above. If you plan on
fully funding the account, we can
help you compare whether that tips
the scale. All of the plans
mentioned above are PPO plans
because the HMO options have
essentially priced themselves out of
the market. It's hard to make the
case for any of those plans. Feel
free to run your free quote and
we're more than happy to walk
through how the plans work. With
the above info, you just reduced the
market of dozens of plans down to a
number that comfortably fits on one
hand...maybe two.
Other
important
concepts
to help
you
understand
your
California health
insurance
quote
are:
Question
on the
individual
health
insurance
application
Individual
health
insurance
underwriting
Enrolling
for
Individual
health
coverage
in
California
Download
the
health
application
or apply
online
What can
delay
your
individual
health
application
Options
for
people
who do
not
qualify
To
run your
instant
health
insurance:
California
Individual
Family
health
insurance
quote
California
group
health
insurance
quote