We get many calls from people requesting one thing...
"Catastrophic health insurance"
They have a very defined requirement and it loosely translates to this.
It's actually not a bad way to self-insure and we'll explain the pro's, con's, and the biggest impact on catastrophic coverage in years.
The ACA (Affordable Care Act)
The ACA basically offsets the idea of catastrophic coverage for pure insurance.
We'll walk through the best options to keep your costs to lowest amount available.
Let's get started.
How can we succeed with catastrophic health coverage?
Catastrophic health insurance is basically designed to cover the big medical bills that can wipe someone out financially.
And boy are there many of those these days.
Many people have heard that stat.
Here's one they might not have heard.
The majority of those individuals are insured when the health care expenses occurred.
So we need to be careful.
We want to keep your cost to the minimum but actually have coverage when something big does happen.
Good news and bad news.
We'll start with the Good.
We have a new addition to the catastrophic health offering.
Health Sharing plans...principally AlieraCare.
AlieraCare is NOT insurance.
These are memberships where members share health care costs.
Here's the deal...
If you don't qualify for a tax credit
You're in good health or only want catastrophic coverage
AlieraCare becomes an option we need to consider.
You have to weigh this against the trade-offs of health sharing plans described in the article above.
Let's look at the ACA take on catastrophic coverage.
One of the main tenets of the Affordable Care Act was to standardize the benefits.
Most of this already occurred in California but there were some notable additions.
By law, each plan must cover:
Furthermore, and this is the bigger impact to the search for catastrophic coverage, the law established certain benchmarks.
These are called Bronze, Silver, Gold, and Platinum.
This means we can't really have a plan under the Bronze level except for people under 30.
There is a "Catastrophic" plan level for individuals under age 30
It's actually very similar in benefit and cost to the Bronze anyway.
So what does this do to the whole notion of catastrophic health coverage?
It limits it.
Basically, the lowest priced plan on the market has around a $5000 deductible with a $6250 max out of pocket.
All those carve outs went away.
So what's the net take away?
This is true for both the individual/family market and group health coverage.
There are some important items to first consider.
There are two kinds of people we come across who are interested in catastrophic coverage.
Self-employed people generally make up a lot of this market.
For the lower income individuals who just want to avoid the penalty of not having health insurance, they may qualify for a tax credit.
In this case, the cost of coverage may come down considerably.
Here are income levels:
In this case, you may even get richer benefits (the Enhanced Silver 73, 87, and 94 plans) for the same cost.
That's for lower income Californians. There's help. Call us at 800-320-6269.
For higher income people who want to avoid the penalty and can afford bigger bills, we're basically looking at the Bronze.
A few notes.
If you have health issues, we should really consider the true out of pocket costs.
This is premium and also the Cost Sharing.
Most importantly, the Max out of Pocket.
Max out of pocket is a key criteria to look at when considering catastrophic health coverage as an option.
One important note: The Bronze, Silver (not enhanced), and Gold plans all have the same Max OOP.
This means that if you get a really large bill, you may face the same exposure anyway.
That definitely makes the lower priced plans more advantageous.
The Platinum has a lower max out of pocket but it's also quite a bit more expensive.
We can help you compare the plan options at 800-320-6269 to find the best value. You can also quote the catastrophic plans here.
This is a common question for many people that do not qualify for a tax credit.
It's a legitimate question.
We'll put to the side for now the calls we get daily where someone has a $20K hospital bill and needs insurance.
There are two considerations to look at.
The first is the fact that we now have a penalty for not having health insurance.
You can find more penalty detail here but here's the broad stroke:
The 2.5% usually wins out in California and especially if you make too much for a tax credit.
Let's say an individual makes $50K. That's $1250 annually or just over $100/month.
Okay, let's say the insurance premium is $300/month (no tax credit).
That means the premium is really $200/month (total premium minus the penalty).
And get nothing for it.
In fact, you're really subsidizing other people's health insurance with your penalty.
Of course, as your income goes up, at some point, it makes no sense to go uninsured.
For example, if you make $100K, your penalty might be $2500. That's most of the cost of insurance in the case above.
The penalty is the first concern.
Find out how Trump might affect the ACA penalties and plans.
The underlying reason for catastrophic health coverage is more important now more than ever.
The cost of insurance has spiraled because the cost of the underlying health care has gone parabolic!
Look at the headlines. You're not just buying the ability to go get antibiotics.
Healthcare is hitting an ability curve that is unprecedented. You have to have protection for this.
50%. Those are bad odds. Blackjack is 49/51% and look at those bright lights in Vegas!
At least get the catastrophic level of coverage.
The new plans are guaranteed issue, right? We can just get the plan anytime.
The plans are guaranteed issue which means people cannot be declined due to health.
In order to get coverage outside of Open Enrollment, you need to have large life change events (loss of coverage, move to another area, household change, etc).
More info on the Special Enrollment here.
We have people call in from Feb to Oct with serious health diagnosis and there's not much we can do for them.
It's pretty depressing. Don't be that caller.
Keep in mind that doctors/hospitals will treat you differently if you are uninsured.
Sure, they won't say that publicly but what's the first question a doctor or hospital asks?
"What insurance do you have?"
Don't think for a second that you'll have the same options if uninsured.
Even if paying cash.
Yes, you can come on Nov 1st (for a Jan 1 effective date) but keep this in mind...
Most catastrophic health care expenses occur at hospitals. One emergency surgery or ER visit can quickly run 10's of thousands of dollars
That's really the risk of not being insured.
It's the emergency surgery. The car accident. The ACL tear. The kidney stone.
On and on and on.
We're all healthy.
Until we're not.
Just to be clear, we're not saying these things out of self-interest.
We get the calls. The bad calls. The $50K bill calls.
And there's nothing we can do for them in most cases.
Call us at 800-320-6269 and we can provide all the catastrophic plan options. You can also quote both Bronze level plans and Short Term here.
We'll also make sure you're getting a tax credit if eligible.
If not, we'll find the lowest priced plan that protects you from the "big what if".
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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.
Call us...you will be Pleasantly Surprised. 800-320-6269
We'll quickly see if you have the best priced plan available and if you qualify for a tax credit800-320-6269
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