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Here’s how to find the best health plan based on your needs.
Choosing your health insurance can be overwhelming. It is an important decision for both your needs and budget. Be sure to compare health insurance plans in order to select the best plan available for you and your family. Picking the wrong one can be costly. You might not have the opportunity to change it until the next Open Enrollment Period, which is typically at the end of the year. Make sure to find a health plan that provides you the most comfort and peace of mind.
As you begin comparing options, ask yourself these basic questions:
Are you purchasing insurance for yourself or someone else?
How often do you typically visit your doctor each year?
Are you currently seeking specialists’ care?
Do you have a chronic condition or another issue that will need attention in the coming year (e.g., pending surgery or maternity coverage)?
Your annual household income determines if you are eligible for financial help. Keep that information handy. Note, the only way to apply for financial assistance is through Covered California.
When looking at a health insurance plan, here are five key points to consider:
1. Coverage Level
Most plans available through Covered California feature four tiers of coverage: Bronze, Silver, Gold and Platinum. No matter which metal tier they are in, these plans all offer the same essential health benefits. The difference between the tiers is how much you'll pay for care versus how much your plan will cover..
Bronze
Great option for healthy people who don’t see the doctor often and only take generic prescriptions.
Low premium, high deductible.
Silver
Great option for generally healthy people who expect to get routine care throughout the year and have generic drug prescriptions.
Moderate premium, moderate deductible.
Gold
Best option for people who manage a chronic health condition, taking multiple medications, or have an upcoming procedure.
Higher premium, lower deductible.
Platinum
Best for people managing a chronic health condition, taking multiple medications, or planning for a major procedure.
Highest premium, lowest deductible.
2. Type of Plan
HMO plans require you to visit health care providers who work for or are under contract with the HMO (except in the case of emergency), and often require you to get a referral from your primary care physician (PCP) to see a specialist. A PPO plan has the most flexibility, allowing you to see in-network providers and out-of-network providers for an additional cost. Typically, with health plans, the more flexibility there is, the higher the monthly premiums.
3. Provider Network
What insurance does my current primary care physician or specialist accept? Is there a specific hospital you prefer? Check the directories of in-network health care providers for each plan you’re considering to ensure your preferred doctor is included. The larger the provider network, the more choices you’ll have, but it’s important to know if the in-network doctors are available nearby.
4. Essential Health Benefits
All plans available through Covered California offer the same essential health benefits, including emergency care, preventive and wellness services, hospitalization and more. Make sure the plans you’re considering cover your regular care, including prescriptions. If you take a specific medication, take a look at each plan’s prescription drug coverage (often called a “formulary”) to ensure the medication is covered and how much your out-of-pocket cost would be.
5. Total Cost
Get a sense of the total cost of different plans that best fit your needs by using our Shop and Compare tool here. The short questionnaire will take into account information like your household size, income, age and basic care requirements to recommend plans that might work for you so you can compare monthly premiums and tier options, as well as the estimated total annual cost with everything included for different plans. This tool will also show you if you and your family qualify for financial help that might be available to help lower how much you pay for premiums and out-of-pocket expenses.
For more information, visit EnrollCA.com. If you have any questions, feel free to call us at (800) 650-0922.
Now that you know how to choose a plan, start an application through Enroll CA today.
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