If you’re shopping for medical insurance for year 2024 this article will help you decide health insurance option work best for you and your family. I am an independent and licensed insurance agent in California helping people enroll into affordable and high quality individual family and group health insurance plans. I have contracts with all major medical insurance companies in the state and can compare all of the options discuss about advantages and disadvantages of some and answer any questions you might have.
Even if you’re shopping for health insurance by yourself and don’t necessarily want me as your agent the information presented in this article will definitely help you see a clear picture and make an educated decision and possibly save money on your health insurance premiums for next year.
If you would like me to be your agent of record I’m happy to be of assistance feel free to reach out. I am a Covered California certified insurance agent as well as present all major insurance carriers directly and you can easily find me and delegate me and I can help at no cost. My services are free to the consumers. Insurance companies may pay me directly when I submit an application on your behalf and there is no extra fee or cost added to your premium if you work with me or with an agent.
What You Need to Know About Health Insurance
Okay so now let me tell you all the good stuff that you want to know about health insurance. Keep in mind that all medical plans cover the same basic health care services but vary in other ways such as provider networks premiums your out of pocket cost and prescription drugs coverage.
So let’s go over a few important things that you need to keep in mind when selecting a health insurance plan.
What’s Available on the Market
First you will have to look at what’s available on the market well that’s obvious right. You can easily run a quote on the official website or ask an agent for help. Make sure you check for the subsidies as those are quite generous and those are available through Covered California. I want to say and those could save you some money on the same private insurance plans as Blue Shield Kaiser Anthem Blue Cross Oscar HealthNet VHP Etna and so on.
You will be surprised that there are zero premium plans available for those who qualify. Here’s a very useful table that I use daily to quickly check for eligibility for my clients and you can get a copy of this table on my blog. Keep in mind though that there are maybe subsidies available beyond the income limits that you see here so I encourage you to run a quote and get a clear answer on the qualification for your specific situation.
The Four Main Categories of Plans
Now one more thing when selecting a health insurance plan keep in mind that there are four main categories of plans bronze silver gold and platinum. The plan designs are the same among companies. In other words if you are comparing Kaiser bronze plan with the Blue Shield bronze plan you will have absolutely the same deductible same copay same out of pocket max and so on.
There are additional types of bronze plans though and silver plans. Those will be available directly through the carriers or there could be an HSA bronze plan HSA silver plan so you will have to look at the specifics and understand the plan benefits before selecting them.
Okay so keep that in mind. Don’t look only at the cost and deductible. Deductible is a totally different story and many people don’t understand how deductibles work and pay lots of extra money each month for no deductible plans without any reason like for a gold one. I’ll explain this later but for now just keep in mind that knowing how the deductible works can help you in many ways.
Which Metal Tier Plan Is Right for You?
So you are looking at all this metal tiers and are totally confused which one do you get. The idea is that a bronze plan being high deductible is a good option for those who rarely see a doctor and want a plan with lower premiums for catastrophic coverage. If you are healthy and see a doctor two or three times per year a bronze plan might be a good option for you. Just think about what your expectations are for the next year and you can easily figure out if that’s the case.
Although it’s hard to predict if you’re going to get injured or pregnant or sick in the coming year leverage what you know about your health needs and this will help you make a decision.
Side-by-Side Comparison of All Plans
Now another thing when comparing health insurance plans it’s wise to look at a side by side comparison of all the plans so let’s go over the basics of all the plans.
Bronze Plan As you can see all these plans allow you to have an annual wellness exam at no extra cost. For bronze plans you don’t pay deductible for the first three visits. The lab is a $40 flat and it’s not subject to deductible. The co-pay for the primary care visit and urgent care is $60 $60 and the specialist is $95. This might be a good plan for those that are healthy and rarely go to the doctor. Obviously if you need more care you will have to pay more out of pocket. The maximum out of pocket you pay with this plan is $9,100 for an individual or double for the family. The out of pocket max is what you pay in the worst case scenario and it basically includes the deductible and everything you pay co-pay co-insurance you know everything you pay out of your pocket goes towards this amount and this is the maximum you pay throughout the year out of your pocket.
Silver Plan The silver plan has a lower deductible. There are no restrictions on how many times you can see the doctor and that’s a great value right there. You will pay deductible mostly when you are hospitalized. I’m saying this again with this particular silver plan you only pay your deductible if you have a surgery or are hospitalized. If you see a fixed dollar amount next to the specific procedure that means that this is exactly how much you pay and there is no deductible involved in this case.
Gold Plan The gold plan has no deductible. The co-pays and co-insurance are lower than those for the silver plan. This plan costs more each month but the insurance pays on average 80% of your medical cost and you pay the rest. Same out of pocket rules apply.
Platinum Plan The platinum plan has no deductible. The co-pays co-insurance are lower than those for the gold plan. This plan costs more each month but the insurance pays an average 90% of your medical cost and you pay the rest. Obviously the platinum plan has the highest premium each month. If you are healthy and rarely go to the doctor it might not be a good idea to buy the most expensive plan on the market so you don’t really need to buy a platinum plan.
Minimum Coverage Plans
Now we haven’t discussed about the minimum coverage plans. These are high deductible plans available to those who are under the age of 30. With these plans you basically pay everything out of pocket except for the three non preventative visits to your primary care doctor but those tend to have a bit high out of pocket expenses.
Enhanced Silver Plans
Also we haven’t discussed the enhanced silver plans 73 87 and 94. These offer lower co-pays co-insurance and out of pocket costs for those who qualify. You only qualify for these enhanced silver plans based on income so be very careful when completing the application for health insurance. I’ve seen many people rushing through the Covered California application and losing the enhanced silver benefits because they have made a minor mistake on the application.
If you run into an issue with your Covered California application and need help feel free to reach out to me and I can assist. There is no cost asked for my help and you can easily find me in the Covered California and give me permission to fix the problem and assist you with the eligibility and plan selection.
PPO vs HMO — What’s the Difference?
One more thing you might come across while shopping for health insurance and that is PPO HMO and all that stuff all those letters next to the plan. Most commonly people compare a PPO or HMO and are confused what is that.
Well PPOs are preferred provider organizations. Typically the PPO health insurance plans are a little bit more expensive but those would allow you more flexibility. Specifically with the PPO plan you are not required to select your primary care doctor. You can go to any specialist without a referral and you basically can go to any doctor though you will pay less if you see a doctor that’s in network.
HMOs are a bit cheaper but with the HMO you will have to stay in network for care select the primary care provider and get referrals to specialists.
The Penalty for Not Having Health Insurance in California
And lastly I have to mention about the penalty. If you are in California and you don’t have a health insurance plan you may have to pay a penalty unless you qualify for an exemption. The penalty is either 2.5% of your adjusted gross income or $750 per person and half of that for a child. It’s either the percentage or the flat fee depending on what’s more.
Need Help?
If you need help with making sense of your health insurance options feel free to reach out to us. This is exactly what I have been doing for the last several years and have helped many many individuals save money on their health care while choosing the best medical insurance plan. I am licensed and certified in California and by law I’m not allowed to charge anything for my services and your premium will not be higher if you work with me. So basically I’m offering qualified free help at no extra cost to you.
That’s all for now. If you have questions feel free to address it in the comments below or reach out directly to us. I love helping people and of course if you found this information useful please share it. Thank you so much. God bless and stay healthy.