Consumer Guide to obtaining quality health insurance in California.

The health insurance market in California is completely unique unto itself, with many pro’s and con’s and opinions on what works and what doesn’t.

Free California Medical Insurance

If you or someone that you love needs affordable medical insurance in california, quite surprisingly you have a few options.

For kids:

• AIM Program (Access for Infants and Mothers): This is for newborn infants and and pregnant mothers. This is NOT to be confused with AIM Health Plans or GetMed360 which are trumped up discount cards passed off as credible health insurance plans.

• CaliforniaKids: California CHIPS program for children ages 2-18.

• California Children’s Services (CCS) : this is a state program that provides medical insurance benefits for children with qualifying disabilities and conditions.

• Healthy Families: a state run program that provides children from low income families with low cost health and dental benefits.

For Adults: 

1. CalMedicare: provides financial assistance to California seniors, who may need assistance with paying Medicare premiums.
2. County Medical Services Program (CMSP): A county by county program that assists California residents with low income and finding health benefits.
3. Medi-Cal: a federal and state health benefits program provided to California residents with low incomes and or expensive disabilities.

Pre-Existing Condition Insurance Plan: a guaranteed issue california medical insurance plan through the state of California that will cover pre-existing conditions if a resident has been declined within the last 12 months and has been uninsured for the last six months. This is not free health insurance applicants must be a premium for coverage

California Group Medical Insurance

Many California small and large businesses purchase medical insurance in california for their employees for a myriad of different reasons. But the most beneficial is that it raises employee morale, and business owners can write 100% of health insurance premiums on their taxes.

Also, quite a few small business owners will use the California Medical Insurance market to provide health benefits for themselves, especially if they can not find affordable California medical insurance on the private market, or are uninsurable.

Health Savings Account eligible plans are also a big hit with group medical insurance clients, not only can they write off 100% of their health insurance premiums under a group plan as an employer, they can also write off covered medical expenses through an HSA account on a PRE-TAX basis! Resulting in literally, cutting their medical costs 30-50%!

Group Health Insurance plans in California are available to groups with as little as only two employees. Many “Mom and Pop” outfits will enroll in a group plan, if they have been declined in the past or want more comprehensive coverage than an individual and family health insurance policy can provide for them.

With all of this being said, california group insurance is not inexpensive to say the least. Remember, group insurance is Guaranteed Issue-they CAN NOT decline to offer you coverage based on your health history, and these plans cover many expenses that individual plans do not like MATERNITY COVERAGE.

Expect a California small group medical plan to run $300-700 for an individual and $700-2000 for a family.

California Individual & Family Medical Insurance

The Basics:

Individual and Family medical insurance in California is not guaranteed issue like California group medical insurance plans. The only final price is the rate that the insurance company issues your policy at.

Private health insurance plans in California are underwritten. Much like when purchasing a home your interest rate is based on your financial history, in a similar manner private health insurance plans are actually based on a client’s health history.

California unfortunately has a pretty restrictive individual health insurance market. There are only a handful of carriers left who can make this business work with the various mandates that the California Department of Insurance requires each plan have.

In California you can purchase an individual and family health insurance plan from carriers such as Blue Cross, Blue Shield, Aetna, HealthNet, and Kasier to name the main carriers who are price competitive.

Even though there are literally over 100 plans in any giving county, there are just three basic types of plans with very little variation across the board.

High Deductible Health Plan: you may have seen these referred to as consumer driven health plans, major medical, catastrophic or an HSA plan. this is a bare bones no-frills full coverage kind of plan. all medical expenses count toward one plan deductible does it matter if the doctor visit lab testing our patience surgery or a prescription medication. once the deductible is met normally you are covered at 100% for the rest of the calendar year.

The value in this kind of plan is the fact that all expenses count towards the deductible.

For example if you were to go with a cadillac styletype plan that cover doctor visits and medications at a co-pay, those $30-$40 co-pays for doctor visits and $30-$60 co-pays for medications plus usually a $500 deductible for brand drugs would not count towards the plan deductible on your California Medical Insurance policy.

If you like knowing you only have to meet your deductible and that’s it nothing else comes out of your pocket then you need to go with a high deductible health plan. Also keep in mind I high deductible health plan is that necessarily need to have a high deductible. Individuals can get a deductible’s low as $1200-$1500.

Copay Plans: these are similar in design to the benefits enjoyed a large group insurance plans. Dr. visits and medications are usually covered at a co-pay or a flat fee-for-service.

Some have said that copay plans are similar to purchasing a used car based on the monthly payment and not the total cost of the vehicle over the term. one important fact to consider when comparing total pay plans to a high deductible health plan is that most California health insurance plans do not cover lab testing under Dr. copay.

Normally what will happen if your doctor will give you a prescription to go to your local lab facility for diagnostic testing.under most California group health insurance plans lap testing would be covered under the doctor co-pay, not so for individual and family health insurance plans purchased in California.

Hospital Surgical Plans: these types of california medical insurance plans leave the consumer with all the risk in their lap.

 You see a California hospital surgical health insurance plan only pays out if you are hospitalized or needed surgery.

Okay you might be saying to yourself that’s fine that’s all I need insurance for, but the truth is most large claims are for medical services received outside of a hospital setting.

Even though each carrier that offers a hospital surgical plan will have variation and plan design both of these plans are generically the same.

They don’t cover doctor visits lab testing medications durable medical equipment like pacemakers unless they are directly related to an inpatient hospital he stationed and/or inpatient outpatient surgery.

Think for a moment what medical expenses drain the largest health insurance plan in the country Medicare.

It’s not hospital stays that surgeries its prescription medications. Prescription drugs account for at least 25% of all california medical insurance claims.

Some studies show even up to 35 to 45%. Now that should show you that if the health insurance carriers and the government are concerned prescription drugs you should be concerned about making sure your persuasion drug coverage as well.

Because after all if you see yourself unhealthy now I don’t need drug coverage and go with a hospital surgical plan doesn’t cover prescription drugs than if you end up needing medications you will be able to change to a plan that will cover it because you be deemed uninsurable.

Network Repricing
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If you’re california medical insurance policy utilizes a PPO network which is one where you can utilize any any doctor in the network without need for a referral to see a specialist, you will never pay full price for medical services again.

I think it goes without saying California medical insurance carriers would never reimburse in network providers retail rates, no when a doctor joins the health insurance company network they agree to only charge a flat rate for any medical service they provide to that insurance carriers clients.

Network repricing saves clients anywhere from around 30 to 70% off their medical bills until the deductible is met for the year

The way this works is you show your doctor your insurance card they will send the bill to the California health insurance carrier of your choice and a few weeks later you will receive what’s called an explanation of benefits.

Which simply is just an invoice that shows the providers retail rates minus deep discounts for them being in network with the balance being the amount that needs to be paid to provider after the bill has been repriced

Short Term Health Insurance California

If you are without a California Medical Insurance policy, consider going with a temporary or short term california health insurance plan.

As long as you can answer “No” to about 5 health questions, most short term plans will issue coverage by Midnight the same day.

Temporary California Health plans don’t cover pre-existing conditions, wellness benefits and some plans do not cover outpatient
prescriptions drugs.

However, if you are a student, someone between jobs, maybe you’ve been declined for regular renewable plan, regardless of your situation
Short Term Health Insurance in California could be the answer you have been looking for !

California Medicare insurance

Many seniors in California believe that having only original Medicare parts A and B. is not enough to protect them from bankruptcy in case of a major health issue.

For those seniors wanting an insurance product that will cover their out-of-pocket expenses they have two options most of the time:

Medicare Supplement: Private insurance companies sell California Medical Insurance supplemental policies that pay what original Medicare doesn’t.

Mainly this is the 20% left over from part B. though it also definitely includes expenses from part which is commonly referred to as hospital insurance.

Medicare supplement plans are standardized that means that if you purchase a plan f it will have the same exact benefits regardless if you purchase it from Blue Cross or United healthcare, the only difference is the rate you’ll pay.

Medicare supplements do not have networks if your doctor accepts Medicare they accept your supplement -case closed

Medicare Advantage: A Medicare advantage plan is the exact opposite of a Medicare supplement plan. Remember with a Medicare supplement there is little to no out of pocket outside of the premium you play for your supplement and prescription drugs which is covered under a separate plan called part D. you can see any doctor you want with a Medicare supplement.

Now a Medicare damage plan has networks like any regular health insurance plan you’ve ever had they have PPO networks where you can pick and choose any doctor within a network they have HMO networks where you must only use doctors in the network usually in exchange for a lower act pocket.

Medicare advantage plans have co-pays deductibles but most also have an hour out of pocket max and the more popular Medicare advantage plans cover part D. prescription drugs all in one plan without the need for an additional premium.

I’m sure at this point you’re asking yourself why would anybody want a Medicare advantage plan versus a Medicare supplement if there’s co-pays deductibles and networks will the answer is a Medicare advantage plans have very low premiums in fact there are many Medicare advantage plans across the states that don’t charge their members anything that’s right no monthly premium outside of their separate part B. premium. they can do this because Medicare pays them so much each month that you’re on the plant so they get their money one way or another.

There is no one-size-fits-all when it comes to any california medical insurance solution but this is especially true in comes to Medicare you must look at the pros and cons when choosing between a Medicare supplement in a Medicare advantage plan