Every day I help individuals, families and small businesses with questions about their health insurance. I am very surprised about how many people are afraid of using their health insurance because they don't know what their plan covers and what they have to pay when they see a doctor. This isn't good. So, I came up with this comparison of various plans and hope that it will help many of you understand what plan you have and what is your copayment and coinsurance. If you don't have health insurance yet, I hope it will help you compare the plans before you apply. Of course I am available to provide personalized help and assistance to anyone that asks for free! Health insurance is not "one shoe fits all" product, so a knowledgeable agent can benefit anyone that is currently looking into health insurance options.
This is a side by side comparison of various plans by level of coverage in 2016
Please note: Highlighted items are subject to deductible
Bronze
60
|
Silver
70
|
Gold
80
|
Platinum
90
|
|
Individual Deductible/Family deductible
|
$6000
|
$2250
|
no deductible
|
no deductible
|
Brand Drug Deductible
|
$500
|
$250
|
no deductible
|
no deductible
|
Preventative Care Copay
|
No cost
|
No cost
|
No cost
|
No cost
|
Primary Care Visit Copay
|
$70(first 3 visits per year are not subject to the deductible)
|
$45
|
$35
|
$20
|
Specialty Care Visit Copay
|
$90
|
$70
|
$55
|
$40
|
Urgent Care Visit Copay
|
$120copay
|
$90 copay
|
$60
|
$40
|
Prescription Medication Copay
|
100% up to $500 per script after deductible
|
$15
|
$15
|
$5
|
Prescription Brand Drugs
|
100% up to $500 per script after deductible
|
$50
|
$50
|
$15
|
Non-preferred brand
|
100% up to $500 per script after deductible
|
$70
|
$70
|
$25
|
Specialty drugs
|
100% up to $500 per script after deductible
|
20% coinsurance after deductible
|
20% up to $250 per script
|
10%
|
Lab Testing Copay
|
$40
|
$35
|
$35
|
$20
|
X-Ray Copay
|
100%
|
$65
|
$50
|
$40
|
Emergency Room Copay
|
100%
|
$250
|
$250
|
$150
|
Hospital stay
|
100%
|
20% coinsurance after deductible
|
20%
|
10%
|
Maximum out of pocket
|
$6500
|
$6250
|
$6200
|
$4,000
|
Please note that this is a general summary of benefits for the plans in 2016. For specific detailed plan benefits, please see the summary of benefits for your plan. If you can’t locate it, please feel free to reach us. We can gladly assist you and send you the summary of benefits for your specific plan.
Please feel free to reach us:
Diana Polyakov, Insurance Agent, License # 0I21751 Phone: 415-994-4121 www.SFCheapInsurance.com
Please note: Highlighted items are subject to deductible
Bronze
60
|
Silver
70
|
Gold
80
|
Platinum
90
|
|
Cchp HMO $209/month
|
Kaiser HMO $305/month
|
Blue Shield PPO
$386/month |
HealthNet EPO
$509/month |
|
Individual Deductible/Family deductible
|
$6000
|
$2250
|
no deductible
|
no deductible
|
Brand Drug Deductible
|
$500
|
$250
|
no deductible
|
no deductible
|
Preventative Care Copay
|
No cost
|
No cost
|
No cost
|
No cost
|
Primary Care Visit Copay
|
$70(first 3 visits per year are not subject to the deductible)
|
$45
|
$35
|
$20
|
Specialty Care Visit Copay
|
$90
|
$70
|
$55
|
$40
|
Urgent Care Visit Copay
|
$120copay
|
$90 copay
|
$60
|
$40
|
Prescription Medication Copay
|
100% up to $500 per script after deductible
|
$15
|
$15
|
$5
|
Prescription Brand Drugs
|
100% up to $500 per script after deductible
|
$50
|
$50
|
$15
|
Non-preferred brand
|
100% up to $500 per script after deductible
|
$70
|
$70
|
$25
|
Specialty drugs
|
100% up to $500 per script after deductible
|
20% coinsurance after deductible
|
20% up to $250 per script
|
10%
|
Lab Testing Copay
|
$40
|
$35
|
$35
|
$20
|
X-Ray Copay
|
100%
|
$65
|
$50
|
$40
|
Imaging (CT/PET scans, MRI’s)
|
100%
|
$250 copay
|
||
Emergency Room Copay
|
100%
|
$250
|
$250
|
$150
|
Hospital stay
|
100%
|
20% coinsurance after deductible
|
20%
|
10%
|
Maximum out of pocket
|
$6500
|
$6250
|
$6200
|
$4,000
|
Please note that this is a general summary of benefits for the plans in 2016. For specific detailed plan benefits, please see the summary of benefits for your plan. If you can’t locate it, please feel free to reach us. We can gladly assist you and send you the summary of benefits for your specific plan.
please feel free to contact us if you have any questions or need help with CoveredCA renewal, application, subsidy calculation, etc.
This is an example of available plans for a 25-year-old individual living in San Francisco and making $20,000/year (Please note that besides the Subsidy/tax credit, this individual is also eligible for enhanced silver benefits, which decreases the out of pocket costs and deductible)
Please note: Highlighted items are subject to deductible
|
|
Bronze
60
|
Enhanced Silver
87
|
Gold
80
|
Platinum
90
|
Cchp HMO $209/month
-$207 subsidy
=$1/month |
Blue Shield PPO $305/month
-$221 subsidy =$84/month |
Gold Kaiser HMO
$387/month -$221 subsidy =$166/month |
HealthNet EPO
$509/month -$221 subsidy =$287/month |
|
|
Individual Deductible/Family deductible
|
$6000
|
$550
|
no deductible
|
no deductible
|
|
Brand Drug Deductible
|
$500
|
$50
|
no deductible
|
no deductible
|
|
Preventative Care Copay
|
No cost
|
No cost
|
No cost
|
No cost
|
|
Primary Care Visit Copay
|
$70(first 3 visits per year are not subject to the deductible)
|
$15
|
$35
|
$20
|
|
Specialty Care Visit Copay
|
$90
|
$25
|
$55
|
$40
|
|
Urgent Care Visit Copay
|
$120copay
|
$90 copay
|
$60
|
$40
|
|
Prescription Medication Copay
|
100% up to $500 per script after deductible
|
$5
|
$15
|
$5
|
|
Prescription Brand Drugs
|
100% up to $500 per script after deductible
|
$20
|
$50
|
$15
|
|
Non-preferred brand
|
100% up to $500 per script after deductible
|
$35
|
$70
|
$25
|
|
Specialty drugs
|
100% up to $500 per script after deductible
|
15% coinsurance after deductible
|
20% up to $250 per script
|
10%
|
|
Lab Testing Copay
|
$40
|
$15
|
$35
|
$20
|
|
X-Ray Copay
|
100%
|
$25
|
$50
|
$40
|
|
Emergency Room Copay
|
100%
|
$75
|
$250
|
$150
|
|
Hospital stay
|
100%
|
15% coinsurance after deductible
|
20%
|
10%
|
|
|
|
|
|
|
|
Maximum out of pocket
|
$6500
|
$2250
|
$6200
|
$4,000
|
Please note that this is a general summary of benefits for the plans in 2016. For specific detailed plan benefits, please see the summary of benefits for your plan. If you can’t locate it, please feel free to reach us. We can gladly assist you and send you the summary of benefits for your specific plan.
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