How to choose the best health insurance plan?

How to choose the best health insurance plan?

Where to buy health insurance plans?

There are various ways you can research and find health insurance plan. Nowadays, all major health insurance plans offer at least the following benefits: Emergency services, Hospitalization, Laboratory tests, Maternity and newborn care, Mental health and substance-abuse treatment, Outpatient care (doctors and other services you receive outside of a hospital), Pediatric services, including dental and vision care for children; Prescription drugs; Preventive services (such as immunizations and mammograms) and management of chronic diseases such as diabetes; Rehabilitation services.

The best way to compare health insurance plans is by contacting and independent health insurance agent in your community. The independent agents represent most of the carriers, and they can get a quote or a comparison for the major plans in your area. Agents do not charge for their services. The plans will cost the same whether you buy it through and agent or directly through the insurance company. The benefits are obviously in favor of using an agent or a Certified Insurance Agent (CoveredCa).
Depending on your income, you might qualify for a subsidy to pay for health insurance. In California, you can get the subsidy through CoveredCA

When to buy health insurance?

Unless you experienced a “qualifying life event” you can only buy health insurance during the open enrollment. Open enrollment for 2017 will begin on November 1, 2016, and will end on January 31, 2017

How much health insurance cost?

Health insurance cost depends on your age and zip code. Depending on what type of insurance you need, you can choose from the following tiers: bronze, silver, gold and platinum. Bronze plans have the lowest premiums and you pay more out of your pocket if you need medical care. Platinum plans have the highest premium cost and your out of pocket cost is low if you need medical care. For example, here is the sample of health insurance premiums for a 35-year-old female living in San Francisco:

Bronze plans:  $294/month
Silver plans: $371/month
Gold plans: $470/month
Platinum plans: $509/month

If this person makes $30,000/year than she will get a subsidy and her monthly premiums will be:

Bronze plans:  $131/month
Silver plans: $209/month
Gold plans: $307/month
Platinum plans: $347/month

*This is average, the cost of various HMO and PPO plans may be different.

So, what insurance plan to choose?

-          If you are healthy, consider getting a bronze or a silver plan. This way you will save on monthly premiums and still be covered for major medical care.

-          If you are pregnant or need extensive medical care, then it will probably be wise to select a plan with a better coverage like gold and platinum plans.

What is deductible, coinsurance, copay, out of pocket?

In order to illustrate all of the above, here is a table which shows all of the above for various plans: (this is for year 2016)

	Bronze plans (cover 60% of the cost)	Silver plans (cover 70% of the cost)	Gold plans (cover 80% of the cost)	Platinum plans (cover 90% of the cost)
Deductible	$6000	$2250	No deductible	No deductible
Primary Care Office Visit Copay	$70*	$45	$35	$20
Coinsurance (ex. Hospital stay)	You pay 100% until you reach the deductible	You pay 20%	You pay 20%	You pay 10%
Annual Out-of-Pocket Maximum	$6500	$6250	$6200	$4000

*the above numbers are for illustration purpose only. For specific costs, please refer to your Summary of Benefits.

What is deductible? - The deductible is the amount you pay for SOME medical procedures, before the insurance company starts paying. If you are enrolled in a bronze plan your deductible is $6000.  You will pay the deductible only if you incur medical bills for certain medical care. If you only see your doctor once a year and never go to emergency, hospital, etc. you will not have to pay the deductible.

What is a copay? a copay is the dollar amount you pay when you visit your doctor. If you have a silver plan you will pay $45 each time you visit your primary care doctor.

What is coinsurance? A coinsurance is a percentage amount you pay for certain medical services. If you have a gold plan, you will pay 20% coinsurance for your hospital stay. So if your hospital bill is $1000, you will pay $200 coinsurance.

What is the out-of-pocket maximum limit? This is the sum of deductible + copays + coinsurance per year. If you have a platinum plan and your already paid $4000/year in copays and coinsurance, then the insurance companies pays for everything else for the rest of the year.

Where I can find doctors that take my health insurance plans?

Each health insurance plan has a network of doctors. It is wise to use in network doctors, hospitals and clinics in order to get a better cost. You can find doctors that accept your plan by referring to your plan’s doctor’s network (online or by calling the toll free number of the carrier).

What is a HMO? – this is a health maintenance organization. If you have an HMO plan (for example Kaiser) you can only seek care from that specific HMO organization. Your plan won’t be accepted by the provider that does not participate in this network

What is a PPO? – this is a preferred provider network. You are free to see any doctor, but you usually pay less if you get care from the provider that is in network with your insurance company.

If you have specific questions, please feel free to reach us anytime. http://www.SFCheapInsurance.com  - Diana Polyakov is an Independent Insurance Agent (Lic. 0I21751), contracted with major health carriers in California such as: Blue Shield of California, Anthem Blue Cross, HealthNet, Kaiser Permanente, Cigna, United HealthCare, Delta Dental, CCHP; she is a certified insurance agent with CoveredCa. Ph. 415-994-4121