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California health insurance  -  Covered California questions  -  Exchange Plan Benefits

California Releases the Health Exchange Plan Benefits

 

Plan benefits for new California Exchange release (detail below)
Subsidies will affect plan choice (detail below)
Access final release of Health Change plan benefits

 

A look at the California Metallic health plans

 

First, some pointers on reading the plan benefits since there are a few layers of complexity on top of just standard benefits. We'll provide guidance based on what we know now which will definitely change going forward. There are 4 basic plan types and one catastrophic plan for younger people under age 30. The four basic plans are Platinum, Gold, Silver, and Bronze in decreasing benefit and cost. If you see a "SHOP" at the top of the benefit matrix, that means the plan is available for group health insurance in California. If you see

 

"Individual", that means it is available for Individuals and Family (as opposed to group health coverage).

 

Breakdown of California health plan benefits

 

The plans are standardized at each metallic level. For example, a Bronze plan will have the same benefits across the different carriers and networks (HMO, PPO, etc).  There are three main areas to focus on (aside from the monthly premium).  The deductible, the Out-of-pocket Max, and the copays.  Really, the deductible and max are where you'll see big swings up and down the levels.  Deductibles are $5000, 2000, 0, and 0 going down the scale.  The max is actually the same for the bronze, silver, and gold plan.  Therefore, the platinum is really for people expecting very large medical expenses. 

 

It can very confusing but we can quickly size up the right plan level for you situation in 5 minutes.  Call now at 800-320-6269.

 

The effects of Subsidies on the California Exchange plans

 

Income is the key driver of everything now. 

 

It affects how much you'll pay and even if you'll get richer benefits as part of the Enhanced Silver plan options. The 100%-150% means that you make between 100% and 150% of the Federal Poverty Levels. Due to this income level, you will get richer benefits than someone making 150%-200%, 200-250% of poverty. This is in addition to subsidies that you will receive up to 400% towards the monthly health insurance premium. The subsidy qualified health plans are very rich by today's standard. We haven't seen plans like those in 10 years.

 

What to expect with the Covered California plans

 

A few important considerations. We still have California HSA options which is great news. The benefits are very very rich on everything but the Bronze plan which means that the vast majority of those without a subsidy will stay with a grandfathered plan or choose the Bronze. In the Exchange, the Silver and Bronze reign due to cost considerations and the fact that no carrier wants to offer the best Platinum plan on the market (adverse selection). Even with subsidies, the rates will be so high on the richer plans that many people may move down in benefits as well. Keep in mind that you have to make very little to qualify for a subsidy at 138-150% so cost is still the main concern even if subsidized.
It's confusing...let us do the work for you.  

 

Call us at 800-320-6269 with the following information:

  1. Best estimate for gross household current year income (we can help with this...it's complicated)
  2. # of household members (all those that file taxes together; enrolling or not)
  3. Dates of birth for enrolling members and zip code

 

You can also send this information  to help@calhealth.net 

 

We'll try to find the maximum subsidy available at no cost to you.

 

Related Pages:

 

Penalties for not purchasing California health insurance
Subsidies to help buy California health coverage
 

You can run your Covered Ca Health Plan Quote here to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!