California health
insurance
California health
coverage basics
Current individual health plans
The Current California Individual Health
Insurance Planscape
We haven't seen such a rate of change in the
individual and
family health insurance market since....well ever. The last 12-18 months have
been entire available suite of plans drop in half with multiple carriers
completely switching out their available plans. It's time to take another look
at what's available now before the next, even bigger change takes place at the
beginning of 2014 with the mandated Health Reform plans. We'll also make an
educated guess as to what that might look like. Let's take a look at the
current market and see what makes sense. We don't expect too many changes over
the next year and half since it will all change Jan 1st. Let's jump in...what
makes sense right now.
 Right now, you have
5 major California carriers that have
any strength in the market along these lines: benefits options, pricing,
network, and ease of dealing with. We'll assume those are the big four on
everyone's mine...especially pricing. The carriers are Kaiser, Blue Shield of
California, Anthem Blue Cross, Health Net, and Aetna. We'll focus on those
since they have best staying power and more likely to make it past the Health
Reform gauntlet. A few key points to set the stage.
HMO's are dead. They're way to expensive on the California
individual health insurance market. Unless someone else is paying your premium
and you don't mind have more narrow networks and structured benefits, look at
PPO or HSA. Maternity is covered on all plans effective July 1st, 2012.
Preventative benefits are also covered on all plans so we scratch that off our
list as well. If you're on an older plan, it definitely makes sense to see
what's available on the market. Which plans then are priced well now?
There are a few suites out of the dozens of plans that make
sense when your Individual health quote. We'll break it down by Carrier. Keep
in mind that age, area, and family make-up can make certain plans more
competitive (just because of how claims have come down) than for other ages,
areas, and make-ups.
Mid-Level Benefits. When running a price quote, we usually
take a quick look at Anthem $3500 Smart Sense both Generic RX and Upgrade RX
(identical pricing except for medication coverage). For mid to low level
pricing, this plan is hard to beat. You can always go up in benefits but look
at the annualized premium difference. In most situations it's hard to justify
the extra premium for the received benefit. It's true going the other way (to
less rich benefits) except for one exception which we'll discuss next in the
Catastrophic section. Shield has a comparable suite of plans called the Shield
Wise plans. Here, just compare the deductibles and premium between the two and
this is a solid approach.
Catastrophic Coverage. If cost is the driving factor (and
let's face it...it is for most people and rightly so with all the increases over
a decade). Here, we look at either
Anthem's Clear Protection $3300 or any of
Health Net's PPO plans which are priced inordinately low. There's a real
argument to be made for just using California health insurance to cover the big
bill and saving on the premium side. These plans fit that bill.
HSA Plan. Finally, the HSA plans are priced as well as
they used to be but if you fully fund the separate HSA account, the net savings
can make them competitive. They also have very low max out of pockets for the
big bill although smaller bills will be subject to the main deductible (outside
of preventative). For HSA plans,
Shield's Savings Plans have been the best
option.
Kaiser Plan. Kaiser is almost a world unto itself. You
either want Kaiser or you don't and within their suite of plans, the higher deductible plans make more sense as is the trend throughout the broader market.
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
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