California health insurance  -  health insurance for California individuals  -  How to choose health plan

How to Choose Individual California Health Insurance

There are some important questions to ask before you run your individual health insurance quote.  One of the main issue people have when they request a quote is the sheer number of health plans that come up.  It can be overwhelming and cause you to doubt your choices especially if you are new to individual health insurance market in California.  Below are a series of question to ask yourself which should narrow the options down to a few key plans that fit your needs.

1.  HMO or PPO? 

This is really a key question to address up front as the two models are very different.  People usually have a strong preference for one or the other but in case you are new to the concept, here is a quick list of differences between HMO's and PPO's:

HMO's are:
   1) more structured in how you access care,
   2) tend to have richer benefits (less out of your pocket when sick or hurt)
   3) cost more in monthly premium. 

PPO's are:
   1) more flexible in which doctors you can see and how that happens
   2) tends to cost-share more of the out-of-pocket with you in the form of deductibles, copays, and co-insurance
   3) has a wide range of monthly premium amounts depending on the level of benefits.

Clearly, the trend today is towards PPO's as the cost of health care in general has spiraled over the past decade.  HMO's tend to have richer benefits but due to this coverage, they are absorbing more of the escalating health care costs over time.  Individual and Family health insurance is very different than Small Group health in that you are essentially covering yourself so it usually makes sense to keep your monthly premium down.  That money is going out the door whether you use the plan or not.

HMO's might work well for people who are flexible in terms of which doctors they can see; want to keep their costs down when they get sick or hurt; and/or considering maternity.

PPO's work for people who would rather save on their monthly premium but share more when sick or hurt; cover catastrophic bills more; require flexibility in terms of doctor access.  


 Recommendations:  Blue Cross PPO's, Blue Shield PPO's, Health Net HMO's

2.  Carrier strength and flexibility

This is an important concern as your plan/rate is only as good as the carrier.  Plans and rates can and do change.  Carriers that do not competently manage their business show a great deal of change in both.  Since health insurance is potentially a long term concern and changes in health prevent us from changing plans, you want to choose a strong carrier up front.  All the major carriers offer large suites of different plans to address your health needs including HMO's, PPO's, HSA


3.  Coverage for office visits and prescriptions?


As long as maternity is not an issue, the no-deductible PPO plans on the market are hard to beat.  They are priced at a middle to low price point.  Make sure to go with the Comprehensive RX option (not the Generic only or No RX) as medication costs have become a significant risk and will continue forward as faster pace.  These plans combine low premiums, office and RX copays, with no deductibles.
 

Hopefully, this will help narrow the multitude of plans on the market to a few that work well for your situation.  You can can now run your California individual health insurance quote or ask us questions regarding your particular situation.   

Other important concepts to help you understand your California health insurance quote are:

Individual health insurance underwriting
Health Savings Account introduction
HMO and PPO comparison

 


                         

 

 



 

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