Wouldn't be nice if we had a simple roadmap to the complicated and confusing world of California health insurance.
A guide that would keep up from the pitfalls and maybe steer us in the right direction towards some understanding of how the product works?
Okay...it's an auspicious undertaking and we won't hope to cover all the various facets but aim to give the California health insurance shopper a basic overview of the market, the plans, and the strategy on how successfully navigate.
Next stop...market segments in the California market.
The California market breaks up into three main categories which are primarily divided by the laws that regulate them.
The first is individual and family health insurance which is regulated by the Department of Insurance and Department of Managed Care. I guess we're lucky in California to have to Departments but it can be get confusing.
For the end consumer, the DOI is probably the place to start regarding law enforcement and regulation questions. The big deal with individual and family coverage is that it is medically underwritten by private carriers for most individuals and families.
This means we need to qualify based on health.
The carriers can decline or change rates based on certain tiers depending on our health status/history at the time of underwriting but not afterwards due to changes in health after your policy has started.
This marketplace covers individuals under age
65 (except for disabled individuals under age
65). Once you turn age 65, you're then into our
next market segment...Medicare.
Medicare is an entirely new set of statutes, this time Federal as part of the Medicare program.
The core program is sponsored by the Federal Government and medicare.gov is the best intro to this new world.
The program is primarily designed for individuals over age 64 and the permanently disabled under age 65. The program is divided into Part A (hospital), Part B (physician), and Part D (medication). The first one is financed with payroll taxes during the life of a working individual while the other two require a monthly premium for most people (depending on income).
There is a separate private market available provided to supplement traditional Medicare know as Medigap or Medicare supplements and another private market for Medicare Advantage plans that actually supplant Medicare.
Both have advantages and disadvantages which
Finally, there is the California group health or employer based marketplace.
This segment is generally regulated by AB1672 (State) and ERISA (Federal) laws. The big difference with group health insurance is that it can be guaranteed issue (offered regardless of health) depending on the group's setup.
This guaranteed issue status can extend all the way down to 2 lives (2 people...owner or employees).
California group health plans are offered by private carriers as well and the three main qualifications to gain access to AB1672 is that we have at least 2 employees, the employer pay at least 50% of the employee's premium, and 75% of the eligible employees go with the plan.
We discuss the many facets of these segments across dozens of articles which you can access from Insurance Center.
So how do we shop these various segments and
compare options? We thought you would never ask.
From our site www.calhealth.net , you can quote and compare all three types of plans available on the market instantly with a quick request for information.
It's important to specify up front which segment you want since they are very different (pre-65 individual/family, Medicare, and Group health) with very different rates, plans, and options.
Once you run your instant quote, make note of
a few key items that will help you navigate the
plans with great confidence.
Let's concentrate on the big three so we don't get lost in the detail (of which there is plenty). 1. Deductible/Max. 2. Premium. 3. Prescription. These are really the key concerns in that order.
The deductible max (it's a combination of two number since you're pretty likely to hit the max if you meet your deductible in today's world) is the place to start. It basically says what to expect for a really big bill. The premium offset to moves up and down along the deductible/max scale is the next concern as you're paying for the difference.
Finally, we can no relegate prescription to a
secondary thought. It's too important and is
increasingly a very expensive risk for more
serious situations. If you can find a plan that
feels good along these three criteria, you're
90% of the way there.
Of course, we have specialized in all three segments for almost two decades now and we're happy to walk through your specific California health insurance requirements to help you find the right fit.
Call us at 800-320-6269 with any questions. Our services are free to you as licensed health agents.
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20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable
We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.
We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.
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