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California health insurance  -  Health insurance articles for California  -  How to use your health plan

How To Get the Most Out of Your California Health Plan

Your health insurance plans is very costly these days so nothing is more frustrating than when you don't get the full benefit out of it when sickness or injury occurs. It can be quite costly to use your plan incorrectly or not to take full advantage it.

Here are a few quick tips to help you get the most of you California health insurance plan.

Understand the health plan you are purchasing.

People go in the quoting engine and they just want to get it over with. We commiserate...it's not fun. They see a few numbers that sound about right followed by a premium that's in their budget and rush on to the online application. They figure that they're healthy...they won't need it anyway. STOP.

First, find a knowledgeable California health insurance broker (hint hint...us at www.calhealth.net) and ask the questions that are most important to you. It's good to research health insurance online but even with the detailed articles on our site, a good agent or broker can really help the process. Half the time, the applicant will go with a less expensive plan after speaking with us, and half the time, more expensive. The important part is that you have the right plan and this will be different for each person.

Interestingly, there are two main camps of incorrect plan choice that we run into.

1. Buying too little health insurance coverage.

With the rate increases year after year, the market is quickly pushed to the lowest hanging fruit...catastrophic plans and even hospital only coverage. Of course these tend to be some of the least expensive plans on the market. The problem is that you could wind up with a $20,000 bill that's not covered. This defeats the purpose of having insurance. There is usually a comprehensive plan that's comparable or slightly higher price-wise.

We can help you find it.

2. Too much health insurance coverage.

 It rarely makes sense to go higher than the low-middle to middle priced plans, especially since you have to be healthy to qualify for coverage anyway. When you look at the premium difference over a year's time, it usually makes sense to save the premium and take the higher deductible. If you have a bad year, it's probably a wash since you're saving on the premium. With an average or good year, you keep the premium difference in your pocket.

The final take away is that you really want to know the kind of plan you are buying. We have dozens of pages that help you to analyze the plans and narrow your options but ultimately a professional agent on the other side of a phone is nearly impossible to beat. Or...you can spend the hours studying yourself.

Work within the rules of your California health insurance plan

This can be quite different between PPO and HMO plans so let's look at both.

HMOs.

HMO's by definition are much more structured and you really need to stay within the rules or you can have quite a bit more out of pocket. The key point is always ask first. Some plans let you self refer to specialist but don't assume. Your Primary Care physician is your point of contact for all care. Run any moves by the office first. This can include procedures you want done (MRI, diagnostics, etc); seeing a specialist; and emergency or out of area care.

Your take away is always Authorize before; Ask during; and Notify after. Make sure to also take advantage of low cost preventive check ups and labs. Ask your primary care about Annual check ups, preventative treatments, and other benefits.

Great Guide to Differences in the California Networks

PPOs.

The key point with PPO's is to stay in network and price shop. By definition a PPO plan is a big group discount. The carrier tells the doctors that contract with it on a PPO basis, "We're going to bring a lot of patients your way, but in return, discount your services when they come in". If you go out of this network, you will pay more out of pocket.

Sometimes, much more.

 Another key points that most people don't realize is that you can and should shop health care services on the market within the PPO network. For example, I needed an MRI for an ACL repair and the doctor recommended the local hospital (which happens to be one of the most expensive in the State).

I asked if there was an alternative and the doctor referred me to a competing imaging center. The cost at the hospital would have been $2000 while the imaging center was $800 for the exact same service. As long as the doctor recommends the alternative, check their PPO prices. Now that deductibles and cost sharing are a main component of PPO plans, enrollees need to change their mindset.

Healthcare is one of the few (if not only) market where people do not think to "shop".

This will change significantly going forward as the difference is money in your pocket. The old plans with very rich plans are gone primarily because they promoted a disconnect between the consumer (you) and the actual cost of health care.

Prescription coverage and your California health insurance plan

Brand name medications and their subsequent direct marketing to the consumer have significantly altered the healthcare landscape (and your monthly premium). This will only continue as new and more targeted medications hit the market. They are expensive but also very effective so it's a mixed blessing.

Work with your doctor to see if there is a generic that will work instead of a brand name medication. You will pay much less out of pocket this way with either HMO or PPO's. If your doctor is fine with the alternative, give it a try. Some of the most popular plans on the market only cover generic RX or cover brand RX after a very high deductible (usually $7500).

Generics will probably work for many common situations but there are times when a generic is not available and those are going be expensive drugs most likely.
With these general tips, you should be able to get the most out of your California health insurance plan.
 

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

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