There are some important questions to ask before you run your individual health insurance quote. One of the main issue people have when they request a quote is the sheer number of health plans that come up. It can be overwhelming and cause you to doubt your choices especially if you are new to individual health insurance market in California. Below are a series of question to ask yourself which should narrow the options down to a few key plans that fit your needs.
1. HMO or PPO?
This is really a key question to address up front as the two models are very different. People usually have a strong preference for one or the other but in case you are new to the concept, here is a quick list of differences between HMO's and PPO's:
HMO's are:
1) more structured in how you access care,
2) tend to have richer benefits (less out of your pocket when sick or hurt)
3) cost more in monthly premium.
PPO's are:
1) more flexible in which doctors you can see and how that happens
2) tends to cost-share more of the out-of-pocket with you in the form of
deductibles,
copays, and
co-insurance
3) has a wide range of monthly premium amounts depending on the level of benefits.
Clearly, the trend today is towards PPO's as the cost of health care in general has spiraled over the past decade. HMO's tend to have richer benefits but due to this coverage, they are absorbing more of the escalating health care costs over time. Individual and Family health insurance is very different than Small Group health in that you are essentially covering yourself so it usually makes sense to keep your monthly premium down. That money is going out the door whether you use the plan or not.
HMO's might work well for people who are flexible in terms of which doctors they can see; want to keep their costs down when they get sick or hurt; and/or considering maternity.
PPO's
work for
people
who
would
rather
save on
their
monthly
premium
but
share
more
when
sick or
hurt;
cover
catastrophic
bills
more;
require
flexibility
in terms
of
doctor
access.
Recommendations:
Blue
Cross
PPO's,
Blue
Shield
PPO's,
Health
Net
HMO's
2. Maternity coverage needed?
Maternity
is one
of the
few
covered
benefits
that you
can
actually
plan
for.
You do
not plan
a broken
leg but
maternity
is
different.
It is
also a
very
expensive
benefits
(simple
delivery
averages
$10K and
C-Sections
start at
$20K)
with
high end
deliveries
in the
100's of
thousands.
If
maternity
is a
consideration,
soon or
in the
future,
you
really
want to
make
your it
is
covered
due to
the risk
of high
out-of-pocket
expenses.
We
recommend
plans
that
cover
maternity
for any
female
in her
20's
and/or
30's
even if
not an
immediate
concern.
If a
person's
health
changes
(or she
becomes
pregnant),
it may
be
impossible
for that
person
to
change
plans
later.
This
question
will
quickly
narrow
your
options
available
on the
market.
You want
either a
lower
high
deductible HSA plan
or a
traditional
PPO plan
with
office
and RX.
HMO's
also
work in
this
case
since
maternity
is so
expensive.
Recommendations:
Blue
Cross
Share
1500,
Blue
Cross
Lumenos
1500 or
3000,
Blue
Shield
$750 PPO,
Blue
Shield
$2400
HSA
3. Carrier strength and flexibility?
This is an important concern as your plan/rate is only as good as the carrier. Plans and rates can and do change. Carriers that do not competently manage their business show a great deal of change in both. Since health insurance is potentially a long term concern and changes in health prevent us from changing plans, you want to choose a strong carrier up front. All the major carriers offer large suites of different plans to address your health needs including HMO's, PPO's, HSA (Health Savings Accounts) and even catastrophic coverage. You can find a great current comparison of the California health insurance carriers but the synopsis is that we would recommend Anthem Blue Cross, Blue Shield of California, and Health Net in that order (although Shield and Health Net are pretty comparable). Cross and Shield tend to be more pragmatic about individual underwriting so if you have any health issues or medications, that would be your first consideration.
4.
Does my
age
affect
the plan
options?
Age is
the
single
biggest
driver
for
health
insurance
costs as
the
average
health
care
costs
for a
person
doubles
every
decade
of their
life.
If you
are in
your
40's,
50's,
and
60's, it
is hard
to beat
a high
deductible
(towards
the HSA
side)
health
insurance
plan.
Basically,
compare
the
annual
premium
difference
with a
richer
plan.
If the
difference
is
$1000+
annually
(sometimes
more the
actual
high
deductible),
then the
high
deductible
plan is
hard to
beat.
We
recommend
going
with the
lowest
cost,
comprehensive
plan.
Comprehensive
is key
here.
There
are many
plans on
the
market
that
carve
out
benefits
(hospital
only or
no Brand
RX).
Try to
avoid
these.
The HSA
plans
typically
are the
lowest
cost,
comprehensive
plans so
that's a
good
place to
look.
Recommendations:
Blue
Cross
$3500
HSA,
Blue
Cross
$3500
PPO,
Blue
Shield
$4000
PPO
5. Coverage for office visits and prescriptions?
As long
as
maternity
is not
an
issue,
the
no-deductible
PPO
plans on
the
market
are hard
to beat.
They are
priced
at a
middle
to low
price
point.
Make
sure to
go with
the
Comprehensive
RX
option
(not the
Generic
only or
No RX)
as
medication
costs
have
become a
significant
risk and
will
continue
forward
as
faster
pace.
These
plans
combine
low
premiums,
office
and RX
copays,
with no
deductibles.
Recommendations:
Blue
Cross
$Right
Plan $40
Comprehensive
RX, Blue
Shield
$35,$25
Active
Start,
Health
Net
Simple
Value
$30, $40, $50
Hopefully, this will help narrow the multitude of plans on the market to a few that work well for your situation. You can can now run your California individual health insurance quote or ask us questions regarding your particular situation.
Other important concepts to help you understand your California health insurance quote are:
Individual
health
insurance
underwriting
Health
Savings
Account
introduction
HMO and
PPO
comparison
To
run your
instant
health
insurance:
California
Individual
Family
health
insurance
quote
