The California Health Insurance Marketplace has introduced many cost-effective health insurance plans. With a little research, consumers can save a significant amount of money each year by getting the health insurance plan that’s best for them, their families, and their employees. In the end, they may have more positive feelings about California’s health care system.
Despite the highly visible social action efforts taking place in Sacramento to heal our health care wounds, the big changes will likely be a while away from taking effect. So, in the coming years, there is much that you, as employers, individuals, and families, can do to quell the negative reputation the health care system has and begin to make the insurance process work in our favor.
In this age of online shopping, each year more people shop for their health insurance plans online without knowing which plans are best for them. Most choose the health insurance plan that has a low monthly premium, but then discover that this plan does not fit their needs or the needs of their loved ones or workers. As a result, the costs can be much higher in the long run. Generally, the most appropriate health insurance plan will end up being the most cost-effective health insurance plan, even if it is not the plan with the lowest monthly premium.
Finding the most appropriate and cost-effective health insurance plan can be accomplished through a few simple steps:
1) Contact a professional health insurance agent for a referral or call the agency you find online
2) Ask the right questions:
A. What is the difference between a PPO and an HMO? Which would benefit me the most?
b. What is a deductible, copay, coinsurance, maximum out-of-pocket limit?
vs If I have pre-existing conditions, how will that affect my family’s rate and probability of approval?
d. Do I have to enroll separately from my family?
my. Are there $0 deductible plans available? Would this be appropriate for me? Because? Why not?
F. If I am rejected, what are my alternatives?
gram. For which plans am I most likely to be approved or rejected?
3) Learn about the different types of health insurance plans on the market. This will only take a few minutes to understand.
Here are some great health insurance plans on the market that have very comprehensive coverage and can help you save money.
profitable PPOs
First dollar plans: These plans have a $0 deductible, so the member pays only a percentage (typically 40%) of the negotiated fee for services from policy inception. First Dollar plans typically have a $25 to $40 doctor visit copay. These plans do not include maternity benefits*, which helps keep monthly premiums low.
*This can be a concern for women, but the companies that offer these plans will often allow you to move to their high deductible plan (~$5000 deductible) which includes maternity benefits should the member become pregnant.
These plans include different drug options to choose from…Over the Counter, Generic Only, or Full Prescription (Brand Name).
Some popular first dollar plans on the market include:
or Blue Cross Right Plan PPO 40
o Active start of Blue Shield 25 and 35
or Aetna MC Open Access 25
o Kaiser Standing $25 and $50 Copay Plan
o Simple value of Health Net 30 and 40
Medical/Dental/Vision Plans: These plans have low deductibles that are often equal to your maximum out-of-pocket limits. They also include basic dental benefits and vision exams. These plans do not include maternity benefits and only include a Generic Drug option. Such plans are marketed to the 19-29 age group, but these plans may be appropriate for any age.
Some popular medical, dental, and vision plans on the market include:
o Blue Cross TONIK (has 3 different deductible options)
*TONIK has strict underwriting guidelines. It is advisable to consult your health insurance agent before applying.
o Blue Shield Essential Plans
profitable HMOs
Saver or Value HMO: These plans provide the extremely comprehensive coverage of an HMO, but the addition of a deductible lowers the monthly premium. These plans still have low copays. HMOs are a good option for women planning to become pregnant. The maximum out-of-pocket limit is typically significantly lower than a PPO. When you do the math to equalize the difference in total spending, one can get more for the money with a Saver or Value HMO.
Some popular HMO plans on the market include:
or Blue Cross Saver HMO
o Blue Shield Access Value
HSA Plans
Health Savings Account Plans: These plans are tax-incentive health insurance plans that increase in supply and popularity each year. Many HSA plans have no copays, so general coverage doesn’t start until the deductible is met. This often lowers the cost of the monthly premium, making these plans attractive on the face of it.
Your accountant may recommend an HSA health plan because of its tax advantages. When you open a health savings account through a compatible health insurance plan, it saves you money (up to $2,850 per year now) tax-free. This money can accumulate interest and can be used to pay for your medical services and Medicare premiums (when the time comes) with the use of a debit card that is authorized only for these uses. It is also important that your funds and accrued interest carry over from year to year.
Blue Cross Lumenos plans are designed to encourage preventive care. Annual physicals, OB/GYN exams, and baby care are covered at 100%.
Some popular HSA-compatible plans on the market include:
o Blue Cross Lumenos HSA Plans
o Blue Shield Spectrum Savings Plans
o Aetna MC Open Access HSA Plans
or Health Net Simple Choice HSA
Learning about the health insurance marketplace isn’t as daunting, difficult, or time consuming as most of us fear. In fact, a trusted and professional health insurance agent will be able to help you narrow down your choices so you can choose the most appropriate plans for you, your family, or your employees in just a few minutes.
The next time you’re looking for health insurance in California, take the tips above to heart. Asking the right questions will make you a more proactive, educated, and responsible consumer, and the knowledge you gain will not only help you find the right health insurance plan, but also free you from future hassle and save valuable time and money. . in the long run.
By Erin Fish
Agent/President
EMF Insurance Agency, Inc.
www.emfinsurance.com
(866) 601-8790