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California health insurance - Health insurance articles for California - How to choose a plan

Hold on to your old California health plans

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We're starting to get a glimpse of what awaits Jan 1st 2014 and beyond.

Granted, many things will change between now and then but we can see the vague outlines. There are still many people who are on the old grandfathered plans (effective date prior to 3/23/2010) and were getting questions from them regarding what they should do. This is very important as the rates and plans available to them will likely be very different than what they have and once they make a change, their grandfathered status is gone forever.

Let's take a look at this situation and how to approach the upcoming changes.

If indeed you have a grandfathered plan, our initial guidance is to not make any changes till see actual rates and benefits which should be available around summer of 2013 since we can't reverse and go back to our original plan. These plans (grandfathered health plans in California) are locked which means that no new people can join them other than family members on an existing health plan. Outside of adding family members, any change to the plan will make it no longer an option for you. Usually, locking a plan to new enrollment is the kiss of death for California health plans but this is the rare exception.

What makes this so different?

Grandfathered Plans

The old grandfathered plans are not subject to many of the mandates brought about by health reform. Because of this, they are less expensive in most cases for comparable coverage. Personally, we have an HSA $3500 plan from Anthem Blue Cross and the equivalent plans on the market are much more expensive (50%) every time I run an instant health quote to see what's available. This will probably continue until the old plans are just not viable due a slow loss of members (getting group coverage, etc). In the meantime, making any change to a new plan even now would result in much higher premiums.

There are a few very rich older plans which might make sense to compare with currently available plans even if this results in losing our grandfathered status.

We're happy to take a look at the market in this situation for you.

We just send us your ages, zip code, current plan, and monthly rate.

Pre-Health Reform Days

We're in an interesting window right now until we get the new rates summer of 2013. It doesn't make sense to make changes (other than in the rare situations mentioned above) until we can see what's available. So what do we foresee for the new Exchange plans? There are two important considerations here.

First will be the actual rates and benefits offered. Each carrier will offer up to four California health plans (the Metallic plans) and a lower priced one for young adults.

The baseline benefits for these plans have already been picked in California with the Kaiser $30 copay plan as a guideline for all available plans on the individual and Small Group California health insurance market. These plans will likely be quite a bit more expensive than what we've had on the market (I know...it's hard to believe that's possible) but guaranteed issue (regardless of health). On the face of it, it doesn't look promising if you have a grandfathered plan now. Here's the second wrinkle to the equation.

If your income is between 150 and 400% of poverty (roughly $90K for family of four at 400%), you should receive some subsidy in the Exchange to offset premium cost on a sliding scale.

As we get closer to being able to see rates (officially can enroll October 1st, 2013 for Jan 1st, 2014 effective date) and the effects of these subsidies, that's the time to make a decision on whether the grandfathered status is advantageous. Of course, we're happy to help with this decision.

You can run your Covered California Plan Quote Online to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!

Frequently Asked Questions
▸ How do I choose the right health insurance plan in California?
Start by comparing plan types (HMO, EPO, PPO), your preferred doctors and hospitals, and your expected medical usage for the year. Balancing monthly premium against out-of-pocket costs is key - a lower premium plan may cost more if you use a lot of care. A licensed California agent can help you compare options at no extra cost. See our guide on how to pick the best Covered California health plan.
▸ What is the difference between HMO, EPO, and PPO health plans in California?
HMO plans generally require a primary care physician and referrals to see specialists, while EPO plans skip the referral requirement but still limit you to a network. PPO plans typically offer the most flexibility, including out-of-network access, though availability varies by market - for example, not every carrier offers a PPO in California's individual/family market. Check our California carrier comparison for specifics.
▸ Does getting help from a CalHealth agent cost extra?
No - assistance from CalHealth.net (Goodacre Insurance Services, licensed since 1994) is at no cost to you. You pay the same premium as going directly to the insurance carrier, so using a licensed agent is essentially free guidance. You can reach them at 800-320-6269 or book a free 30-minute call.
▸ Can I keep my existing California health insurance plan or do I have to switch?
In some cases, Californians may be able to hold onto older "grandfathered" plans, though eligibility and availability depend on your specific plan and current state rules. It's worth reviewing whether your current plan still meets your needs compared to today's options. A licensed agent can help you evaluate whether switching makes sense.
▸ Should I add dental and vision to my California health insurance plan?
Dental and vision are generally not included in standard medical plans, so adding separate coverage is worth considering - especially if you have regular dental visits or need corrective lenses. Covered California does offer stand-alone dental and vision plans during Open Enrollment. Learn more about adding dental and vision to Covered California.
The answers above are general information about California health insurance and may change as rates, plans, and rules are updated each year. They are not a substitute for personalized advice. For current, personalized guidance, please contact us, email help@calhealth.net, or call 800-320-6269. Serving California since 1994.
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