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 seen the entire available suite of plans drop in half with multiple carriers completely switching out their 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 since it will all change Jan 1st. Let's
jump in...what makes sense right now?
Right now, you have 4 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, and Health Net.
Aetna is leaving the individual market and no longer accepting applications. We'll focus on these four 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 are way too 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
There are a few suites out of the dozens of plans that make sense when you run 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 due to how claims have come down) than for other ages, areas, and make-ups.
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
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), we look at either Anthem's Clear
Protection $3300 or Health Net's Advantage 3500
PPO plan which are priced very well. 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 not 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
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.
The net net...it's hard to justify going richer
than the Clear Protection $3300 with Anthem or
the Advantage $3500 with Health Net. This is
especially true since all these plans will go
away Jan 1st, 2014 (Health Reform plans) and you
will be able to quote those with and without
Subsidies right through calhealth.net We notify
our clients and visitors of important Reform
updates to help them navigate the coming
Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!