California Health Insurance – The Keys To Finding The Most Appropriate and Cost-Effect Plan

California’s health insurance market has unveiled many cost-effective health insurance plans. With a little bit of research consumers can save a significant amount of money each year by securing the most appropriate health insurance plan for themselves, their families, and their employees. In the end, they might just have more positive feelings about California’s health care system.

Despite the highly visible social action efforts taking place in Sacramento to heal our health care wounds, it is likely that big changes are still a while away from taking effect. So, in the next few years there is a lot that you as employers, individuals, and families can do to quell the negative reputation that the health care system gets and start making the insurance process work in our favor.

In this age of internet shopping, more and more people each year are purchasing their health insurance plans online without knowing which plans are most appropriate for them. Most choose the health insurance plan that has a low monthly premium, but later find that this plan doesn’t fit their needs or the needs of their loved ones or workers. As a result, the costs can be much greater in the long run. Usually, the most appropriate health insurance plan will end up being the most cost-effective health insurance plan, even if it isn’t the plan with the lowest monthly premium.

Finding the most appropriate and cost-effective health insurance plan can be accomplished through a few simple steps:

1) Contact a professional health insurance agent from a referral or call the agency that you find online

2) Ask the right questions:

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

b. What is a deductible, co-pay, co-insurance, maximum out-of-pocket limit?

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

d. Should I sign up separately from my family?

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

f. If I get declined, what are my alternatives?

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

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

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

Cost-Effective PPO’s

First Dollar Plans: These plans have a $0 deductible so the member is paying only a percentage (usually 40%) of the negotiated rate for services from the very start of the policy. First Dollar Plans normally carry a doctor’s visit co-pay from $25 – $40. Such plans do not include maternity benefits*, which helps to keep the monthly premiums down.
*This may be a concern for women, but companies that carry these plans will often let you slide into their high deductible plan (~$5000 deductible) that includes maternity benefits should the member become pregnant.

These plans include different drug options to choose from…No Rx, Generic Only Rx, or Comprehensive Rx (Brand Name).

Some Popular First Dollar Plans in the Market include:

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 Copayment Plan

o Health Net Simple Value 30 & 40

Medical/Dental/Vision Plans: These plans carry low deductibles that are often equal to their maximum out-of-pocket 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 toward the 19-29 age group, but these plans may be appropriate at any age.

Some Popular Medical/Dental/Vision Plans in the Market include:

o Blue Cross TONIK (has 3 different deductible options)
*TONIK has strict underwriting guidelines. It is advisable to consult your health insurance agent before applying.

o Blue Shield Essential Plans

Cost-Effective HMO’s

Saver or Value HMO’s: These plans provide the extremely comprehensive coverage of an HMO, but the addition of a deductible lowers the monthly premium. These plans still carry low co-pays. HMO’s are a good option for women who are planning to become pregnant. The maximum-out-of pocket limit is normally significantly lower than a PPO. When the math is done to equate the difference in total spending one may get more for the money with a Saver or Value HMO.

Some Popular HMO Plans in the Market include:

o Blue Cross Saver HMO

o Blue Shield Access Value

HSA Plans

Health Savings Account Plans: These plans are tax incentive health insurance plans that are growing in supply and popularity every year. Many HSA plans lack co-pays, so general coverage does not start until the deductible is met. This often lowers the cost of the monthly premium which makes these plans enticing at first glance.

Your accountant may recommend an HSA health plan because of its tax advantages. When you open a Health Savings Account through a compatible health insurance plan it allows you to put money away (up to $2850 per year now) tax free. This money can accumulate interest and can be used to pay for your medical services and Medicare premiums (when the time comes) with the use of a debit card that is authorized only for these uses. Also important, your accumulated funds and interest will rollover year to year.

Blue Cross Lumenos Plans are designed to encourage preventative care. They cover Annual Physical Exams, OB-GYN Exams, and Well Baby Care at 100%.

Some Popular HSA-Compatible Plans in the Market include:

o Blue Cross Lumenos HSA plans

o Blue Shield Shield Spectrum Savings Plans

o Aetna MC Open Access HSA Plans

o Health Net Simple Choice HSA

Becoming educated about the health insurance market is not as daunting, as difficult, or as time consuming as most of us are afraid of. In fact, a trustworthy and professional health insurance agent will be able to help you narrow down your choices so that you may choose the most appropriate plans for you, your family, or your employees in just a few minutes.

The next time you are searching for health insurance in California, please take the above suggestions to heart. Asking the right questions will make you a more proactive, educated, and responsible consumer and the knowledge that you gain will not only help you to find the right health insurance plan, but will relieve you from future aggravation and will save you valuable time and money in the long run.

By Erin Fish


EMF Insurance Agency, Inc.

[email protected]

(866) 601-8790

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