The California individual family health insurance market is interesting in that most people in California received their coverage through employers or government.
This leaves a ragtag assortment of individuals that need coverage including students, self-employed, retired individuals (pre-65) and yes...those leaving group health plans. The reasons for leaving group can be varied as are the situations.
Some people are laid off while others are starting their own business.
Most of these individuals have a Cobra option
but they don't realize that the
individual/family market is also an option and
many times, a better option. Let's look at how
to compare your Cobra option against individual
family health insurance on the California
market.
First, a quick warning.
We can't recommend losing your Cobra option before having a confirmed approval in writing from a new carrier for the plan and rate you want. Coverage is guaranteed issue which means you can't be declined based on health now but you want to check your doctors first.
What this means is that the earlier you quote and application for individual coverage, the better. This way, we can get a decision back (usually takes about two weeks) before lapsing your Cobra option.
Cobra is very strict and if they don't receive the opt in letter, it's gone.
As you may know, Cobra is just continuation of the group health plan that you pay for.
Group health insurance tends to be richer in benefits but more expensive than individual.
If you have serious health issues where you're likely to meet the plan deductible and maximum, Cobra might be the better option. It's not possible to compare apples and apples since individual family benefits are much less rich.
Why is that?
An individual is essentially paying for his/her own coverage.
He or she must look at the premium that goes out the door and this calculation has forced deductibles higher over they years. Companies are offering group health insurance to attract and retain qualify employees so the metric is quite different. Never the less, look at your Cobra monthly premium, deductible, out of pocket max, and medication benefits.
Compare those items against a standard individual plan (Maybe a $2K-3K deductible which is the norm) to see what kind of savings you can gain by reducing benefits.
If the annual premium savings makes up fully (or partially) the benefit difference, individual might be the way to go if we can qualify based on health.
You can email us your census info (ages, zip code, current plan and rate) and we'll see what the market has to offer.
You can usually piecemeal Cobra as well.
Maybe one person has health issues (doesn't have to be the previous employee) and you need Cobra for that person but want to get less expensive individual coverage for the other family members. That's fine. Use this to your advantage.
You may also want to get medical coverage
through the private market but keep Cobra for
dental and or vision. Group dental and vision
are much richer than individual so this can be a
good strategy especially if you expect to use
these benefits (orthodontics, up coming dental
work, glasses, etc). Verify with your group
administrator or carrier that you can piece-meal
the coverage but then use this to your
advantage.
Important Pages:
Guide to Covered California Plans
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