Which Health Insurance Plan is the right one for me? 

Health Insurance plans come in many different shapes and sizes. But deciding which plan is best for you depends on a few factors. Primarily what are your medical needs, who is your doctor, and what is your budget. Additionally when it comes to choosing a plan through a health exchange like Covered California, other factors like income, household size and location will play into your decision. 

Regardless if you are getting your health insurance through your work or as an individual , you should always compare your plan options. Below is a guide of things that you can use to help you compare your health insurance plans. 

Premium:  This is the monthly cost of your plan. It is important because you have to pay it every month or you won’t have coverage. It is not the only thing you should look at but is often one of the biggest factors in somebody’s decision process.  If you purchase a health plan outside of a health exchange like Covered California , you will be responsible for 100% of your monthly premium. If you purchase a plan inside of a health exchange like Covered California they may help you pay for a portion of your premium every month. In general the monthly price is connected with how much you pay when you go see a doctor. If your premium is high you will usually pay less when you use the service. If your monthly premium is low you will normally pay more when you use your healthcare services. 

Coverage and Benefits: Insurance can offer planse with a large variety of benefits and costs. Even within the same insurance company there are many different plans. That is why it is important to ask questions and get help if you have questions about your health plan options. Our Community Enrollment Specialists are able to help you navigate through the different options and find a plan that fits your needs and your budge. 

Doctors Networks: For people who are using their healthcare on a monthly basis, ensuring that your doctor is covered by the plan that you choose is very important. If the price is right and the benefits fit your need, but your doctor doesn’t take your plan, it can be hard to get the care you need. Doctors network can change for each plan and will provide you with a wide range of doctors offices, hospitals and urgent care that you can use to get your healthcare. We can assist you to review the available plans and ensure your doctor participates with the plan you choose. 

Out of Pocket expenses – Day to Day usage and expenses: This can be expenses like Co-Insurance, Co-Pays, Deductibles and Out of Pocket Maximums. These are the costs that you are responsible for when you use your health plan. Co-pays are set amounts that you pay for services. For example if you have a  $15 copay for a doctor visit you will pay the $15 when you go see the doctor. Co-Insurance is a percentage that you pay for certain procedures. This is usually a split between you and the insurance company. For example if the Co-Insurance is 20% it means you will pay 20% and the insurance company will pay 80% of the cost. Out of Pocket Maximum is the most amount of money you can spend in the year regardless of how big your actual medical bills are within the year. 

Exclusions and Limitations: Every plan has limitations on the services that are provided. Usually they will exclude healthcare services that are optional, cosmetic or not medically necessary. It is important to understand what is , and what is not covered by your healthplan before you enroll. Once you have enrolled in a plan, you may not be able to choose a different one until next year. 

Managed Care Plans 

Health Maintenance Organization (HMO): 

A majority of people enrolled into health insurance plans are enrolled in Managed Health plans or HMO’s. They are full service and cover most services that a person would need throughout the year. These types of plans focus on having a primary care physician (PCP) who is the main point of contact for a patient to get additional services or healthcare. 

The PCP is usually a family doctor , and is the one who works with all the other specialists, hospitals and extended care providers. Under an HMO you must choose a PCP to be your main doctor. These types of plans can be more restrictive than other plans about which health providers you can see and how often. As a result , they tend to be less expensive than PPO or other types of health Insurance plans 

Preferred Provider Organization (PPO) : 

These plans tend to have a lot more flexibility about doctors and networks that can be used. This is because there is not one single PCP that a person must choose but rather a group of doctors who are “in network” who can be seen for set prices and a group of “out of network” doctors who can still be seen but will have a higher cost. The nice thing about a PPO is that you do not need approval from a primary care doctor to see a specialist or to get a second opinion. The downside is that the extra freedom means that your plan is going to have a higher cost than a similar plan that is an HMO. 

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.