California Health Insurance – The keys to finding the most suitable and cost-effective plan

The California health insurance market has revealed many cost-effective health insurance plans. With a little research, consumers can save a significant amount each year by purchasing the most appropriate health insurance plan for themselves, their families and their employees. In the end, they may just have more positive feelings about California’s healthcare system.

Despite the highly visible social action efforts taking place in Sacramento to heal our health care wounds, major changes are likely to take a while. So in the years to come, there is much you can do as employers, individuals and families to quell the negative reputation the health care system is acquiring and make the insurance process work in our favor.

In this age of internet shopping, more and more people buy their health insurance online every year without knowing which plans are best for them. Most choose the health insurance plan with a low monthly premium, but later discover that this plan does not fit their needs or those of their loved ones or employees. This can result in much higher costs in the long run. Usually, the most appropriate health insurance policy will end up being the most cost-effective health insurance plan, even if it is not the plan with the lowest monthly premium.

Finding the most suitable and cost-effective health insurance policy can be achieved through a few simple steps:

1) Contact a professional health insurance provider through a referral or call the agency you find online

2) Ask the right questions:

a. What is the difference between a PPO and an HMO? Which one would I benefit the most from?

b. What is an excess, personal contribution, co-insurance, maximum personal contribution?

c. If I have pre-existing conditions, how will that affect my family’s rate and likelihood of adoption?

d. Do I have to register separately from my family?

e. Are there $0 deductible plans available? Would this be suitable for me? Why? Why not?

f. What are my alternatives if I am refused?

g. Which plans am I more likely to be approved or rejected for?

3) Learn about the different types of health insurance plans on the market. This only takes a few moments to understand.

The following are some great health insurance plans on the market that have very comprehensive coverage and can help you save money.

Cost-effective PPOs

First dollar plans: These plans have a $0 deductible, so the member only pays a percentage (usually 40%) of the negotiated rate for services from the very beginning of the policy. First Dollar Plans typically have a $25-$40 doctor visit co-payment. Such plans do not include maternity benefits*, which helps keep monthly premiums low.

*This may be a concern for women, but companies that carry these plans often drop you into their plan with high deductibles (~$5,000 deductible), which includes maternity benefits should the member become pregnant.

These plans include several drug options to choose from… None Rx, Generic Only Rx, or Comprehensive Rx (brand name).

Some of the popular First Dollar plans on the market are:

o Blue Cross Right Plan PPO 40

o Blue Shield Active Start 25 & 35

o Aetna MC Open Access 25

o Kaiser Permenente $25 & $50 co-payment plan

o Health Net Simple Value 30 & 40

Medical/Dental/Vision Plans: These plans have low deductibles that are often equal to their maximum cash limits. They also include basic dental benefits and vision exams. These plans do not include maternity benefits and only include a Generic Drug option. Such plans are marketed to the 19-29 age group, but these plans can be suitable for any age.

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Some of the popular medical/dental/sight plans on the market are:

o Blue Cross TONIK (has 3 different deduction options)

*TONIK has strict acceptance guidelines. It is advisable to consult your health insurance provider before signing up.

o Blue Shield Essential Plans

Cost-effective HMOs

Saver or Value HMOs: These plans offer the very comprehensive coverage of an HMO, but the addition of a deductible reduces the monthly premium. These plans still have low co-payments. HMOs are a good option for women planning to get pregnant. The maximum out-of-pocket limit is normally significantly lower than a PPO. When the math is done to even out the difference in total expenses, one can get more for the money with a Saver of Value HMO.

Some popular HMO plans on the market are:

o Blue Cross Saver HMO

o Blue Shield access value

HSA plans

Health Savings Account Plans: These plans are tax-advantaged health insurance plans that are growing in supply and popularity every year. Many HSA plans don’t have co-pays, so overall coverage doesn’t kick in until the deductible is met. This often reduces the cost of the monthly premium, making these plans attractive on the face of it.

Your accountant may recommend an HSA health plan because of the tax benefits. When you open a Health Savings Account through a compatible health insurance plan, you can put away money (now up to $2,850 per year) tax-free. This money can accrue interest and can be used to pay for your medical services and Medicare premiums (when the time comes) using a debit card authorized for this use only. Also important: your accrued money and interest carry over from year to year.

Blue Cross Lumenos Plans are designed to encourage preventive care. They cover annual physical exams, OB-GYN exams, and Well Baby Care for 100%.

Some of the popular HSA-compliant plans on the market are:

o Blue Cross Lumenos HSA Plans

o Blue Shield Shield Spectrum Savings Plans

o Aetna MC Open Access HSA plans

o Zorgnet Simple Choice HSA

Getting educated about the health insurance market isn’t as daunting, as difficult, or as time-consuming as most of us fear. In fact, a reliable and professional health insurance provider will be able to help you narrow down your choices so that you can choose the most suitable plans for you, your family or your employees in minutes.

Take the following suggestions to heart the next time you look for California health insurance. Asking the right questions will make you a more proactive, educated and responsible consumer and the knowledge you gain will not only help you find the right health insurance plan, but relieve you of future aggravation and save you valuable time and money on long-term.

By Erin Fish


EMF Insurance Agency, Inc.

(866) 601-8790