Beginning November 1, 2019,
Open Enrollment for Health Insurance plans
will begin nationwide. However, if you are a resident of California, your Open Enrollment started on October 15th and will last until January 31, 2020.
This is the time to re-evaluate your coverage and compare prices from either private health insurance carriers, insurance plans offered by your employer or health coverage offered by the state of California through their Marketplace—Covered California.
Shopping for Individual/Family Coverage
When you are looking for a health insurance plan, remember that due to the passage of the
Affordable Care Act (ACA),
insurers in California or any state, can no longer deny you coverage if you have a “pre-existing condition,” and cannot charge you more based on your health status. The government, both federal and state, can offer you subsidies for your health insurance plan if you meet certain income criteria and if you purchase the
insurance plan
on their government run exchange—Covered California.
(3) Ways to Purchase Individual/Family Coverage
*Call the insurance carrier directly
*Purchase a plan online through the California Marketplace-Covered California
*Contact a licensed agent/broker
Things to Remember When Shopping for Health Insurance
Your Costs: Your
monthly premium cost
is based on a few factors such as your age, where you live, how many people will be on your plan and your out-of-pocket costs. If you are getting your health insurance coverage through a group plan (offered by your employer), your premiums will be calculated differently since you will share in the cost with your employer.
Another factor that can determine your costs is whether you choose an HMO Plan (Health Maintenance Organization) or a PPO Plan (Preferred Provider Organization). The descriptions for both are as follows:
HMO Plans:
*You can only see doctors, other providers and labs that are in your plans’
Network
*Out-of-Network options are not allowed unless there is an emergency or if
your plan gives you pre-approval
*You must choose a primary care doctor whom you will see first, before
getting referred to a specialist or to get lab work done
*Pre-approval must be obtained before you can get many health services
*You usually pay a co-pay for most services
*You are less likely to have a yearly deductible
PPO Plans:
*You can pay less to see providers who are in your plan’s Network
*You can go out-of-network, but will pay more
*You are not required to have a primary doctor
*You don’t need referrals for other health services
*Pre-approvals are not necessary for health services
*You will most likely have a yearly deductible
*You may also have a deductible for hospital care and prescription
drugs