2016 HEALTH INSURANCE WHAT YOU NEED TO KNOW?

This guide will help you better understand your options and enroll in the health plan that best fits your needs.

See if you may be eligible for financial assistance:

Number of people in your household	If your 2016 household income is less than…	If your 2016 household income is between…
1	$16,243	$16,243 – $47,080
2	$21,984	$21,984 – $63,720
3	$27,725	$27,725 – $80,360
4	$33,466	$33,466 – $97,000
5	$39,206	$39,206 – $113,640
	You may be eligible for Medi-Cal	You may be eligible for financial help to purchase insurance through Covered California

See if you qualify for a tax credit.

Health insurance protects you from the what-ifs of life and brings peace of mind, but many of us are concerned about the cost. Financial assistance in the form of a tax credit is available to people who qualify based on household size, income, and where they live. The amount is based on a sliding scale, which means the lower your income, the more help you may receive.  See the chart above or contact us directly at: 415-994-4121 (or by email: diana@sfcheapInsurance.com) to find out how much your plan might cost, and to learn if you qualify for financial assistance or Medi-Cal.

Before you choose your plan, consider these factors:

What level of coverage will you and your family need?

There are a range of plans to choose from based on your overall health and financial status. Here are some things you should consider as you select a plan:

Coverage Level:

• Choose Platinum or Gold if you will need more care. These plans have a higher monthly payment, so when you need medical services you can pay less.
• Choose Silver or Bronze if you’re in good health and don’t need as much care. With these plans you can pay less monthly, but pay more when you need medical services. For those who qualify, Enhanced Silver plans also offer lower out-of pocket payments.
• A minimum coverage plan is also available to people younger than 30 or to those who have received an exemption from Health and Human Services due to unaffordability of coverage or hardship. These plans have low monthly premiums and protect from worst-case scenarios. You can’t use financial assistance to help pay for a minimum coverage plan.

  Expected Costs:

• When considering a plan, be sure you fully understand the premiums, deductibles, copays and out-of-pocket limits you will be responsible for, what kinds of services are covered and whether your current doctors accept the coverage.

Standard coverage benefits by level

Bronze covers 60% Silver covers 70%             Gold covers 80%              Platinum covers 90% Key benefits           of average annual cost  of average annual cost  of average annual cost  of average annual cost

Deductible	BRONZE $6,000	SILVER $2,250**	GOLD no deductible	PLATINUM no deductible
Annual Preventive  Care Visit	no cost	no cost	no cost	no cost
Primary Care Visit Copay	$70*	$45	$35	$20
Urgent Care Visit Copay	$120*	$90	$60	$40
Emergency Room Copay	Full cost up to deductible	$250	$250	$150
Generic Medication Copay	Full cost up to $500 deductible	$15	$15	$5
Annual Out-of-Pocket Maximum for One	$6,500	$6,250	$6,200	$4,000

For a complete explanation of the different coverage levels and to explore your options, please feel free to contact your favorite health insurance agent or us at: 415-994-4121 email: diana@sfcheapinsurance.com! We would be glad to help! 

What provider networks are available in your area?

While all insurance companies offer the same levels of coverage, they offer different plan types and provider networks (the doctors and hospitals in your area that accept your insurance). If you wish to keep seeing your current doctors, find out which plans include them as part of their network.

What type of plan is best for your family?

Most insurance companies offer three types of coverage plan products: health maintenance organizations (HMOs), preferred provider organizations (PPOs) and exclusive provider organizations (EPOs). These plan types define what doctors and hospitals you can visit and how you access certain health services.

• HMOs only cover visits to doctors and hospitals inside the plan’s network.  HMOs often require members to get a referral from their primary care doctor  to see a specialist.
• PPOs pay for visits to doctors both inside and outside the plan’s network, but members pay a higher amount of the cost for out-of-network care.
• EPOs generally don’t cover care outside the plan’s network, but members may  not need a referral to see an in-network specialist.
  It’s important to remember that not all PPOs, HMOs and EPOs are the same. Be sure to get all the details about a plan — like what doctors and hospitals are covered, and what it will cost to see a doctor out of the network — before choosing.

What is the tax penalty? 

As of January 2014, most people are required to have health insurance or pay a tax penalty.

In 2016, the penalty will be 2.5% of your yearly household income or $695 per adult (and $347.50 per child under 18) up to $2,085 per family, whichever is higher.

When to enroll?

The open enrollment starts November 1, 2015 and runs through January 31, 2015. If you miss this period, you won’t be able to apply for health insurance unless you experience a qualifying life event (for example you got married, had a baby, moved to a new location, etc.)

How to enroll? 

If you want help with enrollment,  Covered California Certified Insurance Agents offer free, confidential help. Please feel free to contact us if you have questions or need qualified professional help finding & enrolling in a health plan.