OPEN ENROLLMENT THIS YEAR IS BETWEEN OCTOBER 15TH AND JANUARY 15TH!
Come in and speak with a Covered California Certified Insurance Agent. Most people have a lot of questions about getting the right coverage for their needs: we have helped hundreds of clients find the right coverage at a price that fit their budget.
We also offer many other options for health care coverage, in addition to Covered California, we work directly with most of the top health, vision, and dental insurance companies such as AETNA, United Healthcare, Anthem Blue Cross, Blue Shield of California, and many more. Additionally, we can also help you enroll for Medicare coverage if you are older than 65 years old.
How Health Insurance Works.
- You have a health issue.
- You visit your doctor.
- Your insurance provider reimburses your doctor.
- Or your doctor bills your insurance provider.
What Health Insurance Includes.
- Deductible – The amount you pay each year to cover eligible medical expenses.
- Co-pay – A flat fee for certain medical expenses.
- Co-insurance – A percentage that you pay to share the cost of covered services with your insurance after your deductible has been paid.
- Premium – The amount you pay for your health plan every month.
- Out-of-pocket max – The max amount you will pay a year for coverage.
- Essential benefits – All plans include services such as ambulatory patient services, emergency services, hospitalization, maternity and newborn care, and more.
Basic Plan Types:
- HMO- – Short for health maintenance organization. Most restrictive. Requires you to choose a primary care physician from their provider networks. If you go out of network, you have to pay all medical costs.
- PPO – Short for preferred provider organization. It’s a type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit. Most flexible. You won’t be required to stay in-network for health care like with HMO and you do not have to use a primary care physician. You can go out of network for care, but you will receive less coverage.
- POS – Short for point of service plan. It’s a type of managed care health insurance plan. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. You must choose a primary care physician and you can go out of network and still receive insurance coverage. Out-of-pocket expenses are higher if you do not get referrals for non-network care.
- EPO – Short for exclusive provider organization. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits. You must choose a primary care physician and you can go out of network and still receive insurance coverage. Out-of-pocket expenses are higher if you do not get referrals for non-network care.
4 Reasons to have health insurance:
- Illness – Health insurance covers the cost of treating unexpected illnesses.
- Bills – Health insurance protects you from high medical costs that could potentially lead to bankruptcies.
- High cost – You pay less for covered in-care network health care.
- Penalties – You won’t have to pay tax penalties.
Medicare is the federal health insurance program for people who are 65 or older.
Medicare Advantage plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
A Medicare Supplement Insurance (Medigap) policy, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
For more information, please contact us at 562-867-5200 or schedule an appointment here.