Individual/Family Healthcare and Medical Insurance Plans For Californians

Individual Health Plans – California Health Insurance Buying Guide

Do you need to buy individual or family health insurance in California?

Shopping for health insurance in California can seem a little overwhelming. In addition to private individual and family health insurance plans, California offers a variety of public health insurance programs under the Affordable Care Act, including Medi-Cal and Medicare (older than 65). Individual and family health insurance plans can be purchased with a licensed broker through the state exchange “Covered California” and through a private health insurance company.

Eis Health Insurance Solutions offer free service that helps you uncover a plan based on your unique financial and health needs.

Don’t search for health insurance on your own. Eis Health Insurance Solutions can help you find the right health insurance plan in California.

Contact us today by calling 877-338-1451.

What’s the Current State of Health in California?

The Scorecard in State Health System Performance 2015 by The Commonwealth Fund ranked California 23rd out of 50 states. Our state scored well for healthy living (7th) and avoidable hospital use and costs (14th). It received lower marks for healthcare access (30th) and prevention and treatment (37th).

America’s Health Rankings 2015 ranks the Golden State 16th. It cited a low prevalence of smoking and obesity, as well as a low infant mortality rate, as strengths. Air pollution, a California Health Plans high percentage of uninsured population, and a large disparity in health status by education level, were listed as weaknesses.

Gallup reports the number of California residents without insurance decreased from 21.6 percent in 2013 to 15.3 percent in 2014 (a 6.3 percent drop). That’s compared to a 3.5 percent decrease nationally.

It is important to understand the health risks you face and ensure your health insurance plan gives you the coverage you need to stay as healthy as possible.

What is a Health Insurance Exchange?

Under the Affordable Care Act (ACA), a new system for purchasing health insurance plans was developed. This new system is called an exchange (or marketplace).

The Henry J. Kaiser Family Foundation defines the goal of exchanges as creating “a more organized and competitive market for health insurance by offering a choice of health California ACA plans, establishing common rules regarding the offering and pricing of insurance, and providing information to help consumers better understand the options available to them.”

There are two types of individual/family health insurance offerings:

State-run exchange (Covered California)
Private companies

Do I Really Need to Buy Health Insurance?

Even the most routine activities can leave you vulnerable to injury or illness. A three-day hospital stay costs an average of $30,000, fixing a broken leg can cost up to $7,500, and comprehensive cancer care can cost hundreds of thousands of dollars. Without health insurance, you would be required to pay for your care entirely out of pocket, potentially resulting in financial debt and even bankruptcy.

Health insurance also provides preventive care such as cancer screenings and vaccinations. The right coverage enables you to take charge of, and fully understand, the state of your health.

How Much Does Health Insurance Cost?

California Health Insurance Plans The amount you pay for health insurance coverage will differ based on a variety of factors, including the type of plan you choose, the frequency of care needed, and the type of medical services required. There are three main ways you pay for health insurance:

Premium: what you pay your insurance company each month for coverage. The amount depends on the health plan you select.
Deductible: a set amount you must pay before your insurance company starts paying its share of the bills. Deductibles could be $500, $1,000, or more. Your deductible resets each year.
Copayments and Coinsurance: total plan costs depend on the number of doctor visits, frequency of prescription refills, and other types of medical services. Copays are a flat fee (e.g., $20 to visit a doctor’s office). Coinsurance is a percentage of costs (e.g., 15 percent of the cost of a hospital stay).

What is the Affordable Care Act?

The Affordable Care Act—also referred to as Obamacare—was signed into law by President Barack Obama in March 2010. According to the U.S. Department of Health & Human Services, the law intends to “make health care more affordable, accessible, and of a higher quality for families, seniors, businesses, and taxpayers alike. This includes previously uninsured Americans, and Americans who had insurance that didn’t provide them adequate coverage and security.”

Some of the benefits of the Affordable Care Act include:

No denial of coverage because of a pre-existing condition
Preventative care at no cost
Annual and lifetime coverage caps are lifted
Subsidies to make premiums more affordable
Access to health insurance through marketplaces

How is the Affordable Care Act Impacting California?

California was one of the earlier adopters of the Affordable Care Act and has since been a leader in health insurance enrollment. As of December 31, 2014, 843,607 Californians joined the individual health insurance market from both inside and outside of the Covered California exchange, as reported by The Los Angeles Times.

California, Florida, Texas, and Georgia accounted for about half of the 46 percent enrollment growth rate nationwide for individual policies from December 2013 to December 2014, according to a report from the Kaiser Family Foundation. When newly insured Californians were asked why they decided to purchase health insurance coverage.

Twenty one percent claimed to be motivated by the Affordable Care Act:

“Because it’s the law.”
“Because I didn’t want to be fined.”
“It was required by law. I want to obey the law.”

Seventeen percent cited health problems and/or pre-existing conditions:

“My health isn’t perfect because of my age.”
“Because I’m pregnant and need medical attention.”
“Because I have diabetes.”

Fourteen percent cited precautionary and financial protection:

“In case of emergency, so we won’t get big medical bills.”
“For emergency purposes only.”
“Because I had that motorcycle accident and had a $46,000 bill.”

Thirteen percent cited general health reasons and preventative care:

“Because I wanted to stay healthy for me and my daughter.”
“Get checkups and cholesterol screenings.”
“I need it for basic preventive care.”

Approximately half of all Californians still receive health insurance coverage through their employers, but the number of organizations in California offering health benefits to employees has been declining. In 2014, 58 percent of employers in California provided employees with coverage, compared with 69 percent in 2000. Despite the decline in employer sponsored health insurance, many Californians realize the risk of not having coverage and opt for individual and family plans.

What are the Different Types of Health Insurance Plans in California?

There are four ways to obtain health insurance in California:

Employer-sponsored Plans. Employer-sponsored plans typically come with a few options in coverage. The employer chose group plan options, and employees must pick between these. They often include coverage for dependents, as well as additional coverage for dental and vision care.

State Marketplace Plans. Covered California is a state marketplace that offers on-exchange plans to Californian residents. Marketplaces do not include off-exchange plans.

Private Marketplace Plans. Private health insurance plans can be purchased individually through a broker or through insurance companies. They offer on- and off-exchange plans that are ACA compliant.

State or Federally-Funded Plans. There are several types of state- and federally-funded plans available in California:

Medi-Cal: Free or low-cost health coverage for residents of California who meet requirements for low income eligibility.
Medicare: Federal government insurance program for adults 65 and older, adults under 65 with certain types of disabilities, or with end-stage renal disease.