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Applying to the right California Health Insurance Plan

June 11, 2009 By Phil Lee

Depending on your health condition, you may not be accepted into some plans like individual and family health plans.
Since health plans and rates are vastly different between the individual/family health insurance market, the Small Group market, the Cobra and HIPAA markets. You need to determine which is the most advantageous plans to apply to first. Usually this would depend on which plans have the lowest rates. If in the event you do not qualify for your top plan choice, you need to determine which alternatives to explore and in what order.
Frequently this is dependent on certain deadlines. For example you may be given 45 days after your termination from an employer to decide if you want to accept the Cobra that you are offered. Or you may have a 63 day window to decide if you want to apply for a guarantee-issue HIPAA plan after your Cobra expires.
In addition, the cost of each of these alternatives will have to figure into your decision. If you are unable to figure out the best course of action on your own, you may need the assistance of an experienced health insurance agent to help you select the most appropriate plans to apply to in different markets and in different orders or priority, based on your personal health and medical care needs, your pre-existing conditions, your guarantee-issue options, your risk tolerance and your budget.

How to Shop for Health Insurance in California

June 11, 2009 By Phil Lee

Start by determining what type of health insurance plan you currently have. Are you on:

• Your employer’s group health insurance plan?
• Your parents’ employer group health insurance plan?
• Your former or soon to be ex-spouse’s health plan?
• An individual health insurance plan?
• A Cobra or Cal-Cobra plan?
• A guarantee-issue HIPAA plan?
• A guarantee-issue high risk plan like California’s MRMIP (Major Risk Medical Insurance Program) or AIM (Access for Infoants and Mothers)?
• An employer group plan?
• A college-sponsored campus health insurance plan, with or without off campus coverage?
• A government-sponsored health insurance plan like Medicare, Medicaid, MediCal?
• A military health insurance plan like Tricare or medical coverage through the Veterans Administration?

If you don’t know the answer, you should start by asking your health insurance agent, your current health insurance carrier, your current or former employer, or your employer’s health insurance administrator, also known as a TPA (third party administrator).

In addition, if you don’t know already, find out what the premiums, costs and benefits of your current health plan are, i.e. the:

• Monthly Premium
• Office Visit Copay
• Annual Deductible
• Copays and deductibles for Brand Name and Generic drugs.
• Annual Maximum Out of Pocket Costs
• Maximum lifetime benefits
• Co-insurance percentage
• Hospital Copays or Coinsurance amounts
• Maximum daily or annual benefits if any.
• Maternity coverage if any
• Coverage for Preventive care such as annual Physical Exams, pap smear, mammogram, PSA antigen prostate test.
• Benefit limits not covered above

Once you know the details of your current plan, then you need to determine what your individual circumstances are:

• Are you terminating your employment from your employer?
• Is your former employer going out of business?
• Are you going to be offered Cobra?
• Are you in the election period of federal Cobra or Cal-Cobra?
• Are you being offered Cobra as a dependent spouse?
• Are you past the required Cobra Election period?
• Are you already on Cobra?
• Do you qualify for a guarantee-issue HIPAA plans?
• Do you have any pre-existing health conditions that would preclude you from being accepted into an individual or family health plan?
• Would your pre-existing condition be mild enough to allow you to still be accepted, but at a higher rate level?
• Do you own a small business with 2 or more full time employees including yourself?
• Does your profession have an association that offers guarantee-issue health plans?
• Are you in a low enough income bracket to allow you to qualify for coverage from certain government-sponsored health plans?
• Are you well covered by an employer, but are required to pay a substantial contribution from your paycheck in order to cover your spouse and your children?
• Are you turning 65 within the next 6 months?
• Are you between ages 18 and 23 and on your parents health insurance plan?
• Are you on your parents health insurance plan and about to leave college?

Next, you need to determine which health insurance “universe” or “market” you should be shopping in. The available markets are:

• Individual and family health insurance plan market
• Medicare senior health plans market
• Small business group health care plan market for companies with 2-50 employees.
• Mid market employer group health care plan market for companies with 51 to 200 employees
• Large employer group health care plan market for companies with over 200 employees.
• Association plans market for Individuals or small businesses in certain industries.
• Guarantee issue HIPAA plans market for those coming off of Cobra plans whose plans are ending.
• Government subsidized plans like Medical, Medicaid, Healthy Families, AIM, MRMIP (Major Risk Medical Insurance Plan)

Once you have gone through this exercise and know what type of health insurance plan you have now and what your options will be. Then it should be clear what steps to take next.

If it is still unclear to you what steps to take, then you should consult an experienced health insurance agent. Try to figure out with his/her assistance whether you should start applying to an individual health insurance plan first, or because of health conditions, not waste your time and go directly to a guarantee-issue plan, or try to set up a small group plan, etc., etc.
You may contact an agent at 800-286-7445. By email at [email protected], or go to www.health-insurance.com.

Filed Under: Individual/Family Plans Tagged With: children health insurance, Family Health Insurance, Family Health Plans, Health Insurance California, Health Plans California, Individual Health Insurance, Individual Health Plans

Who should buy Individual and Family Health Insurance Plans

June 11, 2009 By Phil Lee

Health insurance plans are not always provided by employers. In the 60 or so years since World War II it has become customary for employers to provide workers with their health insurance plans. But this was not always the case. During the wage freeze of WWII, Employers were not allowed to raise wages to entice women to join the workforce. Their solution was to provide benefits, starting with health insurance coverage. This has since become an entitlement.

If you are:
1. 0 through 64 years old.
2. Currently uninsured.
3. If you are paying too much for your current health plan.
4. If you change jobs frequently and prefer to have an individual plan as a backup in case you are disabled.
5. If you are self-employed.
6. If you own a small business.
7. If your employer does not offer group health insurance.
8. If your employer offers to pay for an individual health plan on your behalf.
9. If you don’t like the choice of plan offered by your employer.
10. If you are on COBRA.
11. If you are on an expensive guarantee-issue HIPAA mandated health plan.
12. If you are on an expensive out of state health plan.
13. If you are on a health discount program that are frequently disguised as affordable health insurance. These plans are dangerous and are not true health insurance.
14. If you have been laid off or are in between jobs.
15. If you are forced to seek individual coverage due to a divorce.
16. If your employer’s plan does not offer you the providers you need.
17. If you missed your employer’s open enrollment period for coverage.
18. If you got dropped from your parents plan due to age (19 to 24) or lack of full time student status.
19. If you retired before age 65 and need to bridge coverage to age 65.
20. If it costs too much to cover your spouse and children under your employer’s plan.
21. If you just started your own business.
22. If you just immigrated to the U.S.
23. If you plan to travel to other states or countries for a part of the year.
24. If you are uninsured and don’t want to rely on government run county or state hospitals and clinics.
25. If you are a physician with your own medical practice.
26. If you are on a work visa in the U.S.
27. If you are visiting the U.S. for an extended period of time.
28. If you are a Foreign Student.
29. If your College or University does not offer any medical care outside of an on-campus clinic.

Filed Under: Individual/Family Plans Tagged With: California Health Insurance, California Health Plans, children health insurance, Family Health Insurance, Family Health Plans, guarantee issue coverage for children, guarantee issue health plans for children, Health Care Plans, Health Insurance California, Health Plans California, Individual Health Insurance, Individual Health Plans

Learn about California’s Efficient Health Insurance Market

January 1, 2009 By Phil Lee

California regulates health insurance to protect consumers, but does not overly restrict competition and free market forces.

California has a good number of insurance carriers each offering a wide selection of PPO and HMO type plans to consumers, small business and large corporations, in a free market environment.

All the rates, the plans and the benefits offered by all the health insurance carriers in California are pre-approved by the state’s regulatory agencies: the Department of Managed Care and the Department of Insurance. All rate increases are also pre-approved by these state agencies.

Consumers in California can find affordable individual and family health insurance plans that are often one half, one third or less than those offered in states like New York and Massachusetts where well-meaning but misguided state regulations have driven out affordable health insurance plans.

California has a much larger network of physicians and hospitals than most other states. Also, a very high percentage of doctors and hospitals participate in PPO and HMO Networks.

Filed Under: Group Plans, Individual/Family Plans Tagged With: California Health Insurance, children health insurance, Family Health Insurance, Family Health Plans, Group Health Plans, Health Care Reform, health insurance, Health Insurance California, Health Plans California, Individual Health Insurance, Individual Health Plans

Applying to the right California Health Insurance Plan

How to Shop for Health Insurance in California

Who should buy Individual and Family Health Insurance Plans

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