1. What's the best (value) plan now
2. Difference between Blue Cross and Blue Shield
3. Difference between HMO and PPO
4. How are Pre-existing conditions handled
5. Is my doctor in the list
6. Can you break down the PPO plans
7. What does deductible mean
8. What does max-out-of-pocket mean
9. Can the rates change
10. Can a child have a plan alone
1. What is needed to start the process
2. How long does it take
3. Do I submit payment with the application
4. Is there a fee to apply
5. Do I need a physical
6. How can I expedite this
7. Am I locked in for a period of time
8. How is payment handled
9. Can I change my plan later
10. Why should I go with you
This whole question has changed with the Affordable Care Act. Income affects everything now including the plans that are available. It generally comes down to the Bronze and the Silver level, especially if you are offered the Enhanced Silver plans. You can run a quote here but it's probably best to call us at 800-320-6269 so we can take into account tax credits that might be available. More detail here: best Covered California plans
Anthem Blue Cross and Blue Shield of California are separate, competing carriers that compete in the Individual and Small Group markets within California.
Provider Networks The HMO and PPO networks are
pretty comparable between the two and both are
genuinely available in all California counties.
You can find roughly 50K doctors and 400
hospital in either company's PPO network. There
will be individual providers that participate in
one but not the other so double check with the
Online California Doctor Directory
Financial Strength Both carriers are strong and have a long history in the California health insurance market. This is especially true for the PPO model in the State. Health Reform will be a big test to many less well run carriers and we expect Anthem and Blue Shield to make it through.
Plans Both companies offer a wide range of competitive plans across the Individual, Small Group, and Medicare supplement markets. From dealing with the carriers on a daily basis, we feel comfortable recommending either to our clients.
You probably already have a strong feeling about
HMO's and PPO's but we'll look at a snap shot of
With a PPO, You will have access to more providers and with a greater degree of freedom. In return, you will share more of the cost when you access these providers.
With an HMO, how you access your care is more
structured and you will have to stay within a
certain group of providers. The benefits tend to
be richer but the premiums may also mirror this
richness on the individual/family market.
TIP HMO's have become more expensive so compare the annual premium difference with PPO options to make sure you are not paying too much.
Health is no longer a factor in underwriting due to the ACA law. There are also no waiting periods for pre-existing conditions. There are Open Enrollment windows however so it's important to understand how those work. You can find more detail on Covered California rules here: Covered California and Pre-Existing
You can check for your doctor or hospital below. Make sure you specify HMO or PPO. Sometimes, doctors are listed under medical group or a billing doctor so if you do not see your doctor on the list, call their office and ask if they EXAMPLE..."participate in the Blue Cross PPO network".
Online Doctor Listing
This is a simple breakdown and you should read
through the benefit summary for more detail but
it helps to simplify the plans.
PPO plans breakdown into three main categories: Office consultation, Prescriptions, and...pretty much everything else (hospital, labs/x-rays, emergency, surgery, etc..)
Most plans offer some type of immediate coverage for the office consultation and generic drugs. Keep in mind that there can be a separate deductible for Brand Name drugs. The "everything else" is typically subject to the main deductible ($0-$5000 depending on plan). Once you meet your deductible, you pay a percentage until you reach your max-out-of-pocket.
A deductible is an amount that you will pay first before the plan kicks in. Keep in mind that you will still get the discounted rate (usually 30-60% off) on covered benefits, in-network even before you meet your deductible. After the deductible is met, you typically go into a % of the discounted rate. Some benefits such as brand name descriptions may have their own separate deductible.
This basically lets you know how the plan will treat large bills...so called catastrophic or major medical coverage. Your max-out-of-pocket let's you how much you will pay up to for covered benefits, in-network in a calendar year. Usually, the max is per person up to two people maximum.
Rates typically change now on Jan 1st during Open Enrollment for individual and family plans (including Covered Ca) even if you have a mid-year birthday.
Yes. With either carrier, you have a single child or multiple siblings on one plan if they are under the age of 18.
What is needed to start the process
The easiest way to apply for Individual and Family plans including Covered California is to call 800-320-6269 and enroll right over the phone. It takes 5 minutes and will save you hours of headaches. This way, we can also make sure the information is correct and you are getting the most tax credit available to you.
We generally enroll everyone within 24 hours and a confirmation letter arrives by mail in about 7 business days. The first invoice generally arrives about 1 week after that confirmation letter. Find out more about the effective date rules.
An invoice will arrive from the carrier with the first month's premium about 2 weeks after enrollment. We can also take the first payment over the phone for most carriers.
There is no fee to apply.
A physical is not required...only the completed application and first months premium.
Enrolling over the phone and then paying the first month's premium by phone is the quickest approach.
No. The policy can be cancelled or renewed (by payment) month to month.
Once you have paid the first month (binding) payment, you can then create your online account with the carrier. You can manage billing options there.
You can generally change your plan during Open Enrollment at the end of each year or during Special Enrollment Periods. More info on those here.
We concentrate on health insurance for
Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!
YOU MAY STILL BE
ABLE TO ENROLL
In just 15 minutes:
With Existing Account
We can help you:
If Your Income
Is In This Range
Current Years Estimate; All those that file together on one 1040:
|Single Person:||$16k - $47k|
|2 People||$22k - $64k|
|3 People||$27k - $80k|
|4 People||$33k - $97k|
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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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