How to Buy Health Insurance in California

Low Price.

Good Coverage.

Large Doctor Networks.

Those are the components of individual health insurance that every shopper is looking for.  Unfortunately, you can’t have all three.  Now that I’ve burst your bubble, let’s take a look at how to buy health insurance in California.

Take advantage of subsidies

There’s money available to help pay for health insurance for those who qualify.  It only make sense to start by
seeing if your income is within the subsidy limits.  Just go to www.coveredca.com and click on Shop and Compare.  Fill out your income and personal information and the site will let you know if your income qualifies for a subsidy.

If you do qualify, you’ll be using Covered California to enroll but you don’t have to do it alone.  In fact, you shouldn’t do it alone.  Use a Certified Insurance Agent, like those at Castaline Insurance Agency.  Don’t look for a Navigator or enrollment counselor as they aren’t licensed and can’t give you advice on which plan to choose.  Instead get the help of an agent such as Castaline Insurance Agency. It won’t cost you anything to assign an agent to your account.  Take advantage of that.

Get some free help

If you don’t qualify for a subsidy, there is no need to use Covered California at all.  In fact, there are many reasons you shouldn’t use it.

So get an online quote somewhere else.

It’s easy.  All you’ll need is your zip code and date of birth.  You’ll be using an Agent here too.  Once again, they will be your best source of unbiased advice because they work for you and can not only help you choose the right level plan, but choose the right insurance company also.

Check the doctor networks

Have your agent check the doctor networks.  Seriously, take the time to do that.  Narrow networks are the biggest downside to buying individual health insurance today.  Is your doctor in the network for the insurance company you’re thinking about buying?  If not, you’ll likely want to find another company or get used to the fact that you won’t be seeing your doctor any longer.

Another problem arises when you have multiple doctors.  One may be in the network while others are not.  What do you do then?  The answer, unfortunately, is compromise.  You’ll have to go with the company that has your most important doctors and then find new ones to replace the others.

If you can’t find a plan that has your doctor, you still may be able to see her if you choose a PPO.  But you’ll have to see your doctor on at out of network basis at a much higher out of pocket cost.

Choose a plan

Now that you know which insurance company has the doctors you need, it’s time to choose a plan that meets your budget and risk tolerance.

Catastrophic, Bronze, Silver, Gold, Platinum.

Those are your metallic levels and your choices for coverage.  Unless you’re under 30 or can prove that no affordable plan exists, you can rule out the catastrophic plan because you won’t qualify for it.  And if you do qualify, it’s really not something you want if you plan to use your insurance at all during the year.

The remaining 4 options range from Bronze (least coverage and least expensive) to Platinum (most coverage and most expensive).  This chart from Covered California best illustrates the major coverage options.

Pay attention to the deductible (the portion you’ll pay before the insurance company begins paying), copays (the amount you’ll pay for each service you use), and the out of pocket maximum (the most you’ll be responsible for paying in a calendar year).

Choose the plan you can afford which offers the best coverage for your individual or family’s specific circumstance.

Complete an application

Whether you’re using Covered California or buying an individual plan from an independent agent, complete an online application.  This will speed up the process and will help you to avoid any errors that often seem to arise when humans handle paper.

The deadline to apply for coverage is the 15th of each month during open enrollment or the month where you qualify for a special enrollment.  Applying by the 15th of the month will ensure that you receive an effective date of the 1st of the following month.

Make your first payment!

A health insurance company will not issue your policy until you’ve made your first payment, often called a “binder payment”.  The best way to make the binder payment is online at the time of your application.  You can make it later by calling the insurance company or even mailing a check but you will run the risk of missing the payment deadline and voiding your application.

Open your mail

If you get your health insurance through Covered California, don’t ignore your mailbox!  Covered California loves to send mail and you’ll be tempted to set it aside without opening it.  Resist that temptation.  You may need to verify your income or your citizenship.  If you fail to respond to those letters, you may find your subsidy has disappeared or your health insurance has been cancelled.  Either one could spell disaster.

That’s it.  Now that you have the best health insurance you can afford with access to the doctors you need most, you’ll want to keep your plan going.  Pay your bill and ask your agent any questions that arise.

Remember, they work for you.

If you would like help with qualifying for a subsidy, checking doctors, figuring out coverage, or applying for health insurance, please feel free to get in contact with us.