If you are shopping for medical insurance for year 2023, this presentation will possibly
help you decide what 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 are shopping for health insurance by yourself and don’t necessarily want me
as your agent, the information presented in this video will still help you see a clear
picture and make an educated decision and possibly save money on your health insurance
premiums!
If you would like me to be your agent of record, I am happy to be of assistance!
Feel free to reach out!
I am a Covered California Certified Insurance Agent, 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 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 an agent!
o.K.
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 costs, and prescription
drug coverage.
So, let’s go over a few important things that you need to keep in mind when selecting
a health insurance plan.
1.
First, you will have to look at what’s available on the market.
You can easily run a quote on the official web site or ask an agent for help.
Make sure you check for the subsidies as those are quite generous and could save you some
money on the same private insurance plans as BlueShield, Kaiser, Anthem Blue Cross,
Oscar, HealthNet, VHP, Aetna and so on.
You will be surprised that there are $0 premium plans available for those who qualify!
Here is 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- I will post a link bellow.
Keep in mind though that there may be 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.
2.
When selecting a health insurance plan keep in mind that there are 4 main categories of
plans: Bronze, Silver, Gold and Platinum.
The plan designs are the same among companies.
In other words if you are comparing a Kaiser bronze plan with a BlueShield bronze plan
you will have absolutely the same deductible, same co-pays, same out of pocket max and so
on.
There are additional types of bronze and silver plans though
so you will have to look at the specifics and understand the plan benefits before selecting
them.
Don’t look only at the cost and deductible – this will tell you nothing about the plan!
Deductible is a totally different story.
Many people don’t understand how deductible work and pay lots of extra money each month
for no deductible plans without any reason…
I’ll explain this later, but for now just keep in mind that knowing how the deductible
works can help you in many ways!
3.
So, you are looking at all these metal tiers and are totally confused which one do you
get?
Well, 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 premium for catastrophic coverage.
If you are healthy and see a doctor 2-3 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.
Though it's hard to predict if you're going to get injured or pregnant or sick in the
coming year, leverage what you do know about your health needs and this will help you make
a decision.
4.
When comparing health insurance plans, it is wise to look at a side by side comparison
of all the plans.
Let’s go over the basics.
All these plans allow you to have an annual wellness exam at no extra cost.
So, for bronze plans- you don’t pay the deductible for the first 3 visits.
The lab is $40 and is not subject to deductible.
The copay for the primary care visit and urgent care is $65 and specialist visit 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 is $8,200 for one individual or $16,400 for the family.
The out of pocket max is what you pay in the worse case scenario and it basically includes
the deductible and all the copays and coinsurance that you’ve paid throughout the year out
of your pocket.
Let’s look at the Silver plan The silver plan has a lower deductible.
There are no restrictions on how many times you can visit the doctor.
You will pay deductible mostly when you are hospitalized.
I am 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.
I have a link to my web site with the detailed summary of benefits for most of the insurance
plans.
So, check it out!
The gold plan has no deductible.
The copays and coinsurance 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.
The platinum plan has no deductible.
The copays and coinsurance are lower than those for the gold plan.
This plan costs more each month, but the insurance pays on 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.
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 first 3 non preventative
visits to your primary care doctor.
Also, we haven’t discussed the enhanced silver plans 73, 87 and 94.
These offer lower copays, coinsurance 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 as I’ve seen many people rushing
through the CoveredCA 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 CoveredCa application and need help, feel free to reach
out to me and I can assist.
There is no cost for my help and you can easily find me in the CoveredCa and give me permission
to fix the problem and assist you with the eligibility and plan selection.
In the description of this video I have the delegation step-by step instructions that
you can use to give me permission to you CoveredCa account so I can help.
One more thing you might come across while shopping for health insurance and that is
PPO, HMO, EPO letters next to the plan name.
Most common people compare a PPO or HMO?
PPO’s are preferred provider organizations.
Typically the PPO health insurance plans are more expensive, but those would allow you
more flexibility.
Specifically, with a PPO plan you are not required to select your primary care doctor,
you can go to any specialist without an appointment and you basically can go to any doctor, though
you will pay less if you see in network providers.
HMO’s are a bit cheaper but with the HMO, you will have to stay in network for care,
select a primary care provider and get referrals to see specialist.
And lastly, I have to mention about the penalty.
If you are in California and you don’t have health insurance 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 $375 per
child.
It’s either the percentage or the flat fee – depending on what’s more.
1.
? 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
individuals save money on their healthcare while choosing the best medical insurance
plan.
I am licensed and certified and by law I am not allowed to charge anything for my services
and your premium will not be higher if you work with me.
So, basically I am offering qualified free help at no extra cost.
2.
So, that’s all for now.
If you have questions, feel free to address it in the comments bellow or reach out directly
to us.
We love helping people!
3.
And of course, if you’ve found this information useful, please share it and like it and comment!
We will certainly appreciate it!
4.
Thank you so much for watching!
God Bless and Stay Healthy!