It's almost a conspiracy.
How many confusing terms can the health insurance industry come with unique to this product.
It can occasionally feel that way but we're here to break up the cabal and put a little power in the California health insurance shopper's hands.
Enter exhibit 1...Deductible.
So what exactly is a deductible and why has it become almost the deciding factor when choosing health insurance in California.
You can always run your quote here:
We'll try to keep our discussion in layman's terms so it's easy to wrap your head around yet another insurance term.
A deductible is an amount that you must pay first before getting help from the insurance carrier.
A quick caveat there...if you're on a PPO plan (many of us are these days) and you use in-network providers, you'll get an immediate benefit in the form of the negotiated PPO discount which usually brings the total cost down 30-60%.
You would then pay this discounted rate until you have met your deductible. An example always helps.
The deductible resets every Jan 1st regardless of when you started the plan as it happens with other main health insurance parameter (max out of pocket, etc).
Once you meet your deductible for a given situation, it applies to other covered health issues during the remainder of the calendar year.
Each incident does not have it's own deductible.
This means that if you had catastrophic bills for 5 family members, you would not need to meet 5 separate deductibles...only two.
The HSA (Health Savings Account) plans in California are a little different in that all covered benefits including office visit copay and medication are subject to the main deductible.
With most other PPO and HMO plans, you get some number of office visit copays and RX copays before meeting the main deductible although brand name RX usually has its own separate deductible.
On the California individual health insurance market, brand deductibles usually run from $0-$7000 depending on the plan .
They are less on the Group health market and generally run $0 to $6000 on average.
As for main plan deductibles, those usually run from $1K-$6K for individual family and $0-$1K for group.
There's been a steady increase in the deductible levels to offset further rate increases and that continues.
You can access the online application here:
The ACA bill mandates a certain level of benefits which will figure into the available deductible amounts.
Here are general ranges for the deductible by Plan type:
Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!