 |
||||||||||||||||||||||||||||||||
 |
Call Us Anytime |
|||||||||||||||||||||||||||||||
| Affordable California Health Insurance Plans & More! |
209 579-2886 |
|||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||
 |
||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||
 |
||||||||||||||||||||||||||||||||
| Home page | Individual Health Insurance | Medicare Supplements | Group | Dental | ||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||
|
|
Call Us Anytime |
|||||||||||||||||||||||||||||||
| Affordable California Health Insurance Plans & More! |
209 579-2886 |
|||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||
| Home page | Individual Health Insurance | Medicare Supplements | Group | Dental | ||||||||||||||||||||||||||||||||
HOW DO I CHOOSE A CA HEALTH INSURANCE PLAN?
Here are some questions you should ask yourself when choosing a Health Insurance California Plan:
How affordable is the cost of healthcare?
What is the monthly premium I will have to pay?
Should I try to insure most of my medical expenses or just the large ones?
What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?
After I have met my deductible, what percentage of my medical expenses is reimbursed?
What is my maximum annual out-of-pocket expenses utilizing network providers?
How much less am I reimbursed if I use doctors outside the insurance company’s network?
Do I want a Comprehensive Prescription Drug Benefit including both Brand Name and Generic Drugs or a limited prescription drug benefit covering Generic Drugs only?
Do I want Maternity Coverage?
Will I benefit and reduce my taxes by paying my out-of-pocket medical expenses with Pre-Tax dollars?
Does the insurance plan cover the services I/we will be likely use?
Are the Healthcare providers (doctors, hospitals, laboratories and other medical providers) that I use in the CA Health insurance companies network?
If I want to use a health care provider outside the network, will the plan permit it?
How easily can I change primary-care physicians if I want to?
Do I need to get permission before I see a medical specialist?
What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?
If I have a preexisting or chronic medical condition, will the plan cover it?
Are the prescription medicines that I use or in the future covered by the plan?
Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment?
Does the plan cover prenatal care and the costs of delivering a baby?
How can I lower my health insurance costs in CA?
Prices are set and determined by insurance companies, generally on a state-by-state basis. Premiums for group policies cannot vary based on your health status, age, gender or other factors unless you are purchasing a California basic health insurance plan aka value health plan or essential health plan in California. There are some options available that can help you reduce the cost of your health insurance although most of these options will increase your out-of-pocket expenses and should be carefully considered and used only in appropriate situations.
For example:
Instead of insuring most of your medical expenses, choose to insure only the large, catastrophic ones.
Reduce your monthly premium by increasing your deductible and paying more out-of-pocket before the insurance kicks in.
If you are in a POS or PPO plan, use only in-network doctors and services.
Can I buy health insurance if I have a serious illness such as AIDS or diabetes or cancer, or if I have a chronic condition such as high blood pressure or asthma?
Coverage cannot be denied under a
group health insurance CA plan,
if your employer offers one, nor can you be required to pay more for your
health insurance based on your health status.
You may be subject to a
preexisting condition exclusion
period if you have just purchased a new
individual health insurance CA plan. This is generally a time
during which a health plan will not pay for covered care relating to any
medical condition for which diagnosis or treatment was recommended or received
within the six-month period immediately preceding enrolling in the health
plan. This six-month waiting period for preexisting conditions can be offset &
reduced by the number of months a previous health insurance plan was in effect
within 60 days prior to the effective date of the new
CA individual health insurance.
If you are
HIPAA (Health
Insurance Portability and Accountability Act) eligible, however,
you must be offered at least some type of individual health insurance with no
preexisting condition periods. To be HIPPA eligible, you must have had 18
months of continuous creditable health insurance coverage, used up any
COBRA or state continuation
coverage (Cal-COBRA), and must
not be eligible for Medicare or
Medicaid or
Medi-Cal.
Will my health insurance pay my medical expenses while traveling outside the United States?
Check with your CA health insurance carrier to find out what type of coverage you have when traveling abroad and what the coverage limits are. Also, ask if the policy will pay to fly you home or to a country with first-rate medical care. If your plan provides coverage outside the U.S., be sure to carry your insurance policy identity card with you, as well as a claim form. Although many companies will pay “customary and reasonable” hospital costs abroad, very few will pay for your medical evacuation back to the U.S. and these costs can easily exceed $10,000, depending on your location and medical condition.
Medicare
does not provide coverage for hospital or medical costs outside of the
country.
If your health plan does not provide
adequate overseas coverage, you should consider purchasing a separate
International Medical and Travel Insurance
Policy. International Travel
Insurance provides long-term or
short-term health, Life, Medical
and Dental Insurance coverage for groups and individuals, both U.S.
citizens and Non-U.S. Citizens living or traveling outside their home country
for either business, international students studying abroad or cultural
exchange programs as well as trips for pleasure or recreational sports
activities. In addition to International
Health & Life Insurance, coverage may be provided for
Trip Interruption Insurance or
Trip Cancellation coverage,
Emergency Medical Evacuation Insurance,
Benefits also include coverage in the event of
travel and baggage delay,
lost baggage insurance,
emergency medical expenses,
repatriation, reunion and emergency assistance services and much more that are
not covered under most domestic or national plans. For a
International Medical & Travel Insurance Quote
visit our website at: https://www.imglobal.com/travelinsurance/index.cfm?imgac=153053.
For Mexico Trip Insurance on
vehicles and for a Mexico Travel Insurance
Quote visit our website at:
https://apache.secure.mexicaninsuranceonline.com/initial_page.mhtml?aff_id=ATT&agtdst=&lang=
CALFORNIA MEDICAL INSURANCE CA is also available to purchase on CALIFORNIA LOW COST INSURANCE & CA LOW COST AUTO INSURANCE polices. For a CA Low Cost Auto Insurance Quote, visit our website at: http://www.Insurance-etc.com or for a CA Low Cost Auto Insurance Quote, visit our website at: http://www.farmersagent.com/ngroesbeck or http://www.insuranceinmodesto.com
Health Insurance Terms & Definitions:
Deductible: A deductible is the amount of loss paid by you before the insurance kicks in. Either a specified dollar amount, a percentage of the claim amount, or a specific amount of time must elapse before benefits are paid. The bigger the deductible, the lower the premium charged for the same coverage.
Co-payments or Co-insurance: Co-insurance or co-pay is a percentage of each claim above the deductible paid by the insured. For a 20 percent health insurance co-insurance clause, for example, you would pay the deductible plus 20 percent of the covered losses. After the insurer pays 80 percent of the losses up to a specified ceiling, the insurer will start paying 100 percent of the losses.
Managed Care Plans: Managed Care Plans include both HEALTH MAINTENANCE ORGANIZATION’s (HMO Plan) and PREFERRED PROVIDER ORGANIZATION’s (PPO Plan). A Managed Care Plan is an arrangement between an individual or employer, insurer and selected providers to provide comprehensive health care at a discount to members of the insured group and to coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines.
Preexisting Condition: A preexisting condition is a medical condition diagnosed before joining a new plan. Many insurance plans will not cover preexisting conditions and some will cover them only after a waiting period subject to the Health Insurance Portability and Accountability Act (HIPAA) Guidelines.
Primary Care Physician: Under managed care plans such as HMO or POS (Point of Service) plans, the first contact for health care is the primary care physician—often a family doctor, internist or pediatrician. A primary care physician monitors your health and treats most basic health problems. In many plans, the insured must have a referral from the primary care doctor in order to receive covered care from a specialist.
Pet Insurance: Pet Health Insurance aka Vet Insurance or Veterinary Insurance is a product that offers pet owners the opportunity to manage the unknown financial risk associated with their pet’s future healthcare costs through the payment of a simple, affordable monthly/annual payment (premium). Pet Insurance gives you the peace of mind that goes with the knowledge that you can afford to provide your pet with the best veterinary care available at all times. For a Pet Insurance Quote, visit our website at: https://www.petcareinsurance.com/sc_step1.aspx?Country=2&BrokerID=1624
Short Term Medical Insurance: Affordable Temporary Health Insurance for people: between jobs, waiting for employer benefits, Temporary or Seasonal employees, new graduates or applicants waiting for underwriting approval on a recently submitted individual/family health insurance application. Short Term Medical Insurance is not guaranteed renewable! If available, it is recommended to accept a COBRA or Conversion Plan when it is uncertain if and when a guarantee-issue health insurance plan such as an employer-sponsored Group health plan or Medicare will become available. Key features of a Short Term Medical Plan are:
Temporary health insurance for 30-360 days (varies by state)
Coverage as early as the next day
Freedom to choose any doctor or hospital
100% coinsurance option takes the guesswork out of what you owe
For a Short Term Medical Quote, visit our website at: http://stmdirector.eassuranthealth.com/agentlink.aspx?linkid=EC84BE201008EE3C
HEALTH INSURANCE CALIFORNIA MEDICAL PLAN CHOICES:
There are essentially two types of California health insurance plans: indemnity plans (fee-for service) or managed care plans. The differences include the choice of providers, out-of-pocket costs for covered services and how bills are paid. There is no one “best plan” for everyone. Some plans are better than others for you and your family’s health needs, but no one plan pays for all the costs associated with your medical care. Your share of cost and premium will vary depending on the plan you choose.
INDEMNITY PLANS:
Indemnity Health Plans allow you to choose your own medical providers. You can go to any doctor, hospital or other provider in or outside California for a set monthly premium. The plan reimburses you or your health care provider on the basis of services rendered. You may be required to meet a deductible and pay a percentage of each bill. However, there is also often an annual limit on out-of-pocket expenses (OOP Maximum), so that once an individual or family reaches the limit, the insurance covers the remaining eligible medical expenses in full. Indemnity plans sometimes impose restrictions on covered services and may require prior authorization for hospital care or other expensive services. Indemnity plans may allow self-referrals to specialist.
Basic Health Plans aka Value Health Plans or Essential Health Plans provide limited health insurance benefits at a considerably lower cost. When buying such a plan, it is extremely important to read the policy description, limitations and exclusions carefully because these plans don’t cover some basic treatments, such as outpatient services, chemotherapy, certain prescriptions and maternity care. Furthermore, CALIFORNIA rates vary considerably because, unlike indemnity plans or a managed care option, premiums are community rated and are based on age, gender, health status, occupation or geographic location.
Health Savings Accounts (HSA) are a recent alternative to traditional health insurance CA plans. HSA’s are basically a savings product designed to offer individuals a different way to pay for their health care. HSA’s are established at a bank or other financial institution enabling you to pay for qualified health, dental and vision expenses and save for future qualified medical and retiree health expenses on a tax-free basis. Instead of paying a higher premium for a more expensive health plan, you establish a tax-free savings account that covers your out-of-pocket medical expenses with the savings provided by a High Deductible Health Plan (HDHP). This means that you own and control the money in your HSA. You make all decisions about how to spend the money without relying on a third party or a health insurer. You also decide what types of investments to make with the money in the account in order to make it grow. However, if you sign up for an HSA, you are generally required to buy a High Deductible Health Plan as well weather you live in CALIFORNIA or not.
High-Deductible Health Plans (HDHP) are sometimes referred to as catastrophic health insurance coverage. An HDHP is an inexpensive health insurance plan that kicks in only after a high deductible is met of at least $1,000 for an individual or $2,000 for a family.
Cafeteria/Flexible Spending Plans are employer-sponsored CA Group Health Plan that allows the employee to design his or her own employee benefit package, choosing between one or more employee benefits and cash. Several types of Flexible Benefits or Cafeteria Plans are used by employers, including multiple options pre-tax conversion plan, medical plans plus flexible spending accounts, and employer credit cafeteria plans. For more information about these choices, contact your employee benefits department.
MANAGED CARE PLANS:
Health Maintenance Organizations (HMO) offer access to an extensive network of participating physicians, hospitals and other health care professionals and facilities. You choose a primary care doctor from a list provided by the HMO and this doctor coordinates your health care. You must contact your primary care doctor to be referred to a specialist. Generally, you pay fewer out-of-pocket expenses with an HMO, but you are often charged a fee or co-payment for services such as doctor visits or prescriptions. In California, premiums for HMO’s have increased at a higher rate than with High-Deductible Health Plans due to higher utilization by patients because of the lower cost sharing and lower out-of-pocket expenses to use HMO benefits in California.
Point-of-Service (POS) plans are an indemnity-type option in which the primary care doctors in the POS plan usually make referrals to other providers within the plan. If a doctor makes a referral out of the plan, the plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service is covered by the plan, but you will be required to pay co-insurance.
Preferred Provider Organizations (PPO) charge on a fee-for-service basis. The participating doctors, hospitals and health care providers in California are paid by the insurer on a negotiated rate, discounted fee schedule. Costs are lower if you use in-network healthcare services, but you have the option of going out-of-network. If you choose an out-of-network provider, you are generally required to pay the difference between what the provider charges and what the plan pays. PPO’s may allow self-referrals to specialists. Some California PPO Plans pass the savings from the contracted or negotiated rate with the patient using a network provider for services rendered that are subject to an annual deductible or out-of-pocket expense.
Government Sponsored Health Insurance:
Medicaid / Medi-CAL are federal/state public assistance program created in 1965. It is administered by the states for people whose income and resources are insufficient to pay for health care or private insurance. All states have Medicaid programs including California, though eligibility levels and coverage benefits vary.
State Children’s Health Insurance Program (SCHIP) is administered at the state level and provides health care to low-income children whose parents do not qualify for Medicaid. SCHIP may be known by different names in different states, however in California it is referred to as California Healthy Families Program.
Military Health Care includes TRICARE/CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) as well as care provided by the Department of Veterans Affairs (VA).
State-specific Plans are available for low-income and/or uninsured individuals. These plans are known by different names in different states. For example, California provides the California AIM Program (Access for Infants and Mothers) and California Major Risk Medical Insurance Program (MRMIP).
Indian Health Service (IHS) is a Department of Health and Human Services program offering medical assistance to eligible American Indians at IHS facilities. In addition, the IHS helps pay the cost of selected health care services provided at non-IHS facilities.
Medicare is a federal government program for people 65 and older, or those with certain disabilities, that pays part of the costs associated with hospitalization, surgery, doctors’ bills, home health care and skilled-nursing care. Original Medicare Plan provides Part A Hospitalization and Part B Medical. A Medicare Supplement or Medigap policy may be purchased to supplement or fill in the gaps from Original Medicare Part A & B and allows coverage both inside California or in any state other than California.
What is a Medigap policy?
A Medigap policy, (sometimes called "Medicare Supplement Insurance"), is health insurance designed to supplement the Original Medicare Plan, that is, help pay some of the health care costs "gaps" that the Original Medicare Plan doesn’t cover (like copayments, coinsurance, and deductibles). If you are in the Original Medicare Plan and you buy a Medigap policy, then both plans will pay their share of Medicare-approved amounts for covered health care costs.
Insurance companies can only sell you a "standardized" Medigap policy. Standardized Medigap policies are identified by the letter A through L. Medigap Plan F and J also offer a high-deductible option. The Chart below provides a quick look at the standardized Medicare Supplement Plans A-L including the Medicare Supplement Plan F. Medicare Plan F pays the Medicare Part A & B Deductibles and Coinsurance and pays 100% of Medicare Part B excess charges:
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
GROUP HEALTH INSURANCE IN CALIFORNIA:
Should I participate in my employer’s group health insurance? Yes, employer-sponsored Group health insurance plan premiums can be lower priced than those for an individual health insurance plan because the plan is group rated and your employer contributes toward the cost. If your employer gives you a choice of plans, you need to understand your choices and pick the plan best suited for you and your family. Also, for employees and their family members with certain preexisting medical conditions, obtaining coverage through an Employer’s Group Health Plan during open enrollment may provide coverage on a guarantee-issue basis avoiding a lengthy underwriting process which may result in a decline or higher modified rates due to the additional financial risk to the CA Health Insurance Companies associated with the pre-existing condition. Many California Group Health Plans provide a fixed cost for dependant coverage regardless of number of dependants. This benefits large families but may be too expensive for small families with only one dependant. In this case an individual health insurance plan in California may be more affordable subject to medical underwriting based on the applicant’s health and any preexisting medical conditions.
If I change jobs or become unemployed or disabled, can I take my health insurance coverage with me?
If you switch employers, you have the right to carry your group health insurance coverage with you to a new job for up to 18 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
You must pay the full premium and health insurance under COBRA or Cal-COBRA is available if you are in the following situations:
You leave a company and become unemployed or self-employed for up to 18 months.
You are a widow or widower or child of an employee who dies while working for the same company for three years or more.
You are the divorced spouse or child of an employee who has left the company he or she was employed at for at least three years.
You are the child of an employee who left a job and have not yet reached age 23.
NOTE: If you need COBRA or CalCOBRA benefits, you must fill out the appropriate forms from your employer’s benefits department within 60 days of leaving your job. If you do not act within that time, you may be denied coverage.
If my employer does not provide medical insurance in California, can I buy an individual/family health insurance policy?
Yes. You should consider buying an individual health insurance policy if you don’t have health insurance provided for you or your family members.
Here are some other options to consider:
Ask your insurance company if you can convert its group policy to an individual conversion plan. You will pay a higher rate than you did before and your benefits may be limited, but the terms will still probably be better than if you buy your own policy depending on your health history.
If you are married, see if your spouse’s employer will add you to its group plan.
Try to join a California group health insurance plan through a trade association or alumni group or professional association as they may offer reasonable rates.
It is possible also to buy an individual policy. The rates may be high subject to medical underwriting and coverage limited, but it is important that you be protected against financial catastrophe if you, or your family, are hit with a major illness or injury. If you are self-employed, most of the health insurance premium will be tax-deductible.
CALIFORNIA LOW COST HEALTH INSURANCE CA TERRITORIES:
|
ACAMPO
95220
ALAMEDA COUNTY
ALPINE COUNTY
AMADOR COUNTY
BUTTE COUNTY
CALAVERAS COUNTY CENTRAL CA CENTRAL CAL CENTRAL CALIFORNIA
CENTRAL VALLEY
COLUSA COUNTY
CONTRA COSTA COUNTY
DEL NORTE COUNTY ELDORADO ELDORADO COUNTY
EL DORADO COUNTY
FRESNO COUNTY
GLENDALE 91201-91209
GLENN COUNTY
GOLD
RIVER 95670 |
GREENWOOD 95635
GRIDLEY
95948
HUMBOLDT COUNTY
IMPERIAL COUNTY
INYO COUNTY
KERN COUNTY
KINGS COUNTY LA LA COUNTY L.A.
L.A. COUNTY
LAKE COUNTY
LASSEN COUNTY
LOS ANGELAS COUNTY
MADERA COUNTY
MARIN COUNTY
MARIPOSA COUNTY
MENDOCINO COUNTY
MERCED 95340
MERCED COUNTY MODESTO 95355 MODESTO 95356 MODESTO 95357 MODOC COUNTY
MOFFETT
FIELD 94035
MONO COUNTY
MONTEREY COUNTY
NAPA COUNTY
NEVADA COUNTY N. CA N CA N CAL N CALIFORNIA NO CA NO CAL NO CALIFORNIA
NORCO
91760 NORTHERN CAL
NORTHERN CALIFORNIA
OAKDALE 95361
ORANGE COUNTY
PASADENA 91101 |
PHELAN
92371
PETALUMA 94952
PILOT
HILL 95664
PLACER COUNTY
PLUMAS COUNTY
RIVERSIDE COUNTY
SACRAMENTO COUNTY
SAN BENITO COUNTY
SAN BERNARDINO COUNTY
SAN DIEGO COUNTY SAN FRAN
SAN FRAN COUNTY
SAN FRANCISCO COUNTY
SAN
JOAQUIN COUNTY
SAN
LEANDRO 94577 - 94579
SAN LUIS OBISPO COUNTY
SAN MATEO COUNTY
SANTA BARBARA COUNTY
SANTA CLARA COUNTY
SANTA CRUZ COUNTY SD COUNTY
S.D. COUNTY SF COUNTY
S.F. COUNTY
SHASTA COUNTY
SIERRA COUNTY SISKIYOU COUNTY SLO
SLO COUNTY SCAL SOCAL SO CAL SO CALIFORNIA
SODA
SPRINGS 95728
SOLANO COUNTY
SONOMA COUNTY
SO SF SOUTH SF
SOUTHERN CAL
STANISLAUS COUNTY
SUTTER COUNTY
TEHAMA COUNTY
TRINITY COUNTY TULARE COUNTY
TUOLUMNE COUNTY
VENTURA COUNTY
YOLO COUNTY
YUBA COUNTY |
