How to buy California Health Insurance

There are a couple things you should ask yourself before you buy health insurance. What do you want and what do you actually need?

Everyone wants a low deductible, office visit co-pays and good prescription coverage but what a person may need can be far different. Health insurance can get extremely expensive depending if you choose to elect a low deductible health plan with first dollar benefits. Such a plan would serve very well the individual who visits a doctor frequently, although the plan would most certainly come with a hefty price tag. On the other hand, if you are completely healthy and see a doctor but once year, then having a lot of first dollar benefits and a low deductible will leave you paying high premiums for coverage that you never use.

Before you buy a health insurance policy you should take these areas into account.

Are you in good health? (This will determine what is available to you and have a bearing on your monthly premium if approved for a health plan)

How many times do you go to a doctor in a given year?

How much money are you comfortable with in paying a monthly premium?

Do you want strong catastrophic protection for a serious emergency? (a low out-of-pocket maximum)

How important are your first dollar co-pays for doctor’s office visits? (offered before you have to satisfy the deductible)

Is strong prescription drug coverage important to you? (low co-pays for generic, brand and formulary drugs)

When choosing individual or family health insurance, being in good health is critical. Health Insurance carriers are still for-profit businesses (until president Obama says otherwise) and will decline your application if they feel you are a potential risk. This fact alone is why you should consider buying health insurance why you are healthy. Health insurance carriers can not terminate your plan if you come down with a serious illness or have an accident. They also have the right to rate your monthly premium higher than the original rate if you have pre existing conditions.

How many times you see a doctor in a given year will help you (or your insurance agent) determine what type of a plan you need. If you see a doctor but once a year you may benefit from a high deductible health plan (catastrophic plan) that has the availability of one physical exam. In this case you will pay a lower monthly premium your health plan will better fit your lifestyle (until you need better coverage someday). If you see a doctor several times a year then a plan with office visit co-pays before deductible will better suit you.

The old saying “you get what you pay for” rings true when it pertains to health insurance. I am a healthy 27 year old male and what I make a year would not be enough to cover the high premiums I would pay for a low deductible health plan. Let me show you…

The following quotes are with Blue Shield California and are based on a healthy 27 year old male in Sonoma county California.

Shield Spectrum 500 $310
Shield Spectrum 750 $219
Shield Spectrum 1500 $193
Shield Spectrum 2000 $113
Shield Spectrum 5000 $63

The winner in this case would be the PPO Savings Plan 4000 at $54. I would have a physical offered once a year for a $35 co-pay and my out-of-pocket maximum is only $4000 a year. This means after I satisfy the deductible that everything is covered at 100%. Considering I would only need to use it in an emergency, this would be the perfect plan for me.

In the event that you require strong prescription drug coverage you want to be aware that many plans out there will strip the Rx benefits in order to make the premiums more affordable. Many companies will offer generic only prescriptions while some will put “caps” on the yearly maximum pay out. In the event that you have a catastrophic emergency and require expensive brand name drugs you want to make sure your plan offers both brand and generic Rx with no cap on the maximums.

As always, if you have any questions please contact me or J.C. Lewis Insurance Services ; our services are at no cost to you!

California Health Insurance

In the world of California health insurance the average Californian will generally have many health care options available to them. The more health conditions one may have will of course limit these options but it is still important that you speak with a licensed health care professional who can keep you informed. Occasionally I will speak with a client who thinks they are uninsurable only to find that, after submitting their application they get approved at a slightly higher premium. Those people who do get turned down have the option of the MR MIP plan. MR MIP (Major risk medical insurance plan) is a government run health insurance policy that is funded through tobacco taxes. You can expect an inflated premium for the MR MIP plan due to it being a guaranteed issue plan that covers you regardless of health status. Uninsurable people may find they can work this plan into their budget with a little planning. It never hurts to ask for the details! My services are always free of charge and you will always get the most up to date accurate information.

Many Californians will shop around on the internet in order to find the cheapest monthly premium available. While I commend these people for taking the initiative to do their own health insurance research; many never thoroughly examine the health insurance plan at the time they purchase it. A simple glance at the health plan benefits is not enough! Try to imagine yourself in a few different emergency situations, and then ask a customer service representative (with the insurance company) or your insurance agent to explain how specific catastrophic situations will be covered.

California health insurance plans that you see marketed as though they are gold usually have some serious pitfalls to them. The paragraphs below are examples of current plans that are highly marketed because of cheap premiums. I am going to take a few moments and analyze these plans to show you their pitfalls. I’ll make up a few accident scenarios so you can see exactly what kind of coverage you will get on these highly marketed plans. For privacy reasons I cannot disclose the name of insurance carriers or the plan title but I asure you the following story is based off of a real insurance plan that is currently being marketed today!

Andrew and his wife decided to go skiing in Lake Tahoe for a weekend. A few months before their weekend get away Andrew put his wife and himself on Health Plan Plus 900 deductible (name must be changed due to law...but this plan is real and currently being sold in 2009). On the way down the mountain Andrew falls off his skis breaking a leg and fracturing a wrist. The ambulance ride, x-ray, lab and hospital stay rack up a bill of $4000. With the $900 deductible already satisfied Andrew is left with $3100 which the Health Plan Plus 900 will cover at 60% leaving him with a total out of pocket cost of $2140.

But wait…

Andrew was administered Vicodin and Oxycontin medication due to the pain. While the Health Plan Plus 900 covered the Vicodin at a $10 co pay the Oxycontin was a brand named prescription; brand named prescriptions are not covered and Andrew ended up paying the full price at $100. A month later he had to refill the Oxycontin Rx racking up a total cost of $210 in prescription medications!

There is more…

There is a limit of 2 office visit check ups on the Health Plan Plus 900. The first 2 follow up office visits for his wrist and leg were covered at a $40 co pay. Andrew ended up being in a cast for 6 weeks, he needed roughly 3 more follow up check ups for physical therapy sessions once his cast came off. Since Andrew already exhausted his 2 office visit maximum for the year he ended up paying the full amount for each therapy session at $200 each. All five office visits combined totaled $680, none of this amount applied to the co-insurance maximum for the year. This means Andrew only satisfied $2140 of a $4900 out of pocket max for the year (the office visits and Rx co-pays on the Health Plan Plus 900 do not count towards the deductible and out of pocket max). If Andrew has another accident this year he must satisfy another $2760 in out of pocket cost to reach the maximum of $4900. An accident means he must be admitted to the hospital for the $2760 to be satisfied, Rx co-pays and office visits won’t count.

I hope this example will show you the dangers of a plan like the Health Plan Plus 900. Of course, it is better to have this insurance plan than nothing at all but with a quick assessment of your options J.C. Lewis Insurance Services can help find you the right coverage at the right price!