4 Factors to Consider When Choosing a Health Insurance Plan in California

Are you exploring your health insurance options? It’s important to understand what plans are available and best meet your health needs. Educating yourself on the process will help you feel more confident when enrolling in a plan. 

In the United States, it is common for people to secure health insurance through their employer. However, if you do not have access to employer-based coverage, you can consult your state’s online marketplace for available plans. When choosing a health insurance plan in California, you should visit Covered California to explore your options and determine if you’re eligible for Medi-Cal, California’s Medicaid program.

As you navigate the healthcare marketplace, you will want to keep a few things in mind. Here are 4 factors to consider when choosing a health insurance plan for you and your family.

1. Open Enrollment 

Depending on the circumstances, you may have a limited window of time to change or enroll in health insurance. This period is referred to as open enrollment and occurs between November 1st and January 31st. 

There are certain instances where you can enroll in health insurance outside of the open enrollment period. If you experience a qualifying life event or qualify for Medi-Cal, the open enrollment rules do not apply. If you lose your insurance, it is important to enroll in a new plan within 60 days of loss of coverage since health insurance is required by California state law. If you remain uninsured for the year, you will face a penalty of at least $900 per adult and $450 per dependent child. 

As you navigate this process, time is of the essence. If possible, talk with your family members and make a plan to secure health insurance within the required period.

2. Types of Plans 

Another factor to consider is the type of plans you are eligible for. Based on your income, you may qualify for Medi-Cal and receive insurance at no cost. However, if you do not qualify, there are several other health insurance plans available on Covered California’s marketplace. 

You can use the Shop and Compare tool to review your options. The available health insurance plans are arranged in four tiers, including Bronze, Silver, Gold, and Platinum. All of these plans have the same benefits, however, the cost differs depending on the plan you choose. 

Each tier provides additional details to help you make your decision. Within the Silver, Gold, and Platinum tiers, you will need to choose between three types of plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO). These plans differ depending on location and company. Be sure to review each type of plan to determine which plan is right for you. 

You should consider how often you use your health insurance when selecting a plan. Typically, the Bronze and Silver plans are suitable for people who do not use their health insurance as frequently. If you use health services regularly, the Gold or Platinum plans may be beneficial and save you money in the long run.

3. Total Cost & Financial Assistance 

Cost is an important factor to consider when looking for a health insurance plan that fits your budget. As you review your options, consider the costs associated with each plan and take the time to see if you qualify for financial assistance. 

When you compare plans using Covered California’s resources, you will find that each plan has information on the price of monthly premiums, deductibles, and other out-of-pocket expenses. 

The terms associated with health insurance plans can be confusing. We’ve defined some of the terms to know as you navigate the process of choosing a plan. 

Monthly premium: the price you pay the insurance company each month

Deductible: the amount you pay for covered services before your health insurance plan begins to pay

Out-of-pocket maximum: the highest amount you will pay in a year and your insurance will pay the rest

Co-pay: a fixed amount you pay for services such as doctor visits or prescriptions

When reviewing the tiers, you will notice that plans in higher metal categories such as Gold and Platinum have high monthly premiums but lower out-of-pocket costs. The lower metal categories have a lower monthly premium but require you to pay more out-of-pocket. Make sure to consider your budget and medical needs when choosing a plan.

Knowing the cost associated with each plan will help you make an informed decision. Covered California can help you determine if you qualify for financial help based on your household income. If you have questions about your eligibility, set up a time to speak with a representative who can answer any questions you may have.

4. Provider Networks 

Another factor to consider is whether your current doctors are covered by the insurance plan you’re interested in. As you review the plans available through Covered California, you will have access to a list of in-network doctors. You can search for the names of your doctors to determine if they are in network for that plan. However, you may discover that one or all of your doctors may not accept that insurance.

If your doctor is not in-network for that plan, you will need to determine if you are willing to find a new doctor to avoid paying additional out-of-pocket costs. It’s also a good idea to check with your doctors to confirm they accept the insurance you plan to enroll in. 

Conclusion

Human Health Project is dedicated to supporting you on your health journey. Our upcoming patient advocacy workshops will provide valuable information on how to sign up, renew, and maintain your insurance. These workshops are currently held on Zoom and are free to attend. 

Our mission is to empower and educate the vulnerable and underserved, who struggle to understand and access healthcare, leading to improved outcomes and reduced medical errors. Participating in our patient advocacy workshops, online events, and learning academy courses can help you learn more about the insurance process and address your questions about navigating the healthcare system.