2018 is just around the corner and now is the time to enroll in health insurance or switch plans! In California, Open Enrollment is from November 1, 2017 to January 31, 2018. If you are thinking about switching plans, review your policy and ask yourself the following four questions! Take action and enroll before December 15 if you would like your insurance coverage to begin on January 1, 2018.
If this is your first time enrolling into health insurance, this three month time period is the best time to do so. Even those who do not have their SSN or are in the process of applying but still have not received it yet can enroll into health insurance during this time period. However, after these three months are over, unless you qualify for special enrollment, you will not be able to enroll in health insurance. This reason is why many health insurance experts remind everyone to not miss this once in a year opportunity. (Click here to learn more about enrolling into health insurance.)
1) How much did you spend on medical expenses last year?
How much do you currently spend on your health insurance premiums? In the past year, how much did you spend on medication?
Generally, the higher your health insurance premium is, the lower your out-of-pocket medical expenses are; the lower your premium, the higher your out-of-pocket medical expenses are.
For those who do not go to the doctors often, many automatically revert to the Bronze plan because it covers the basic benefits at an affordable price. If you have not even been to the doctor at least once this year, then the Bronze plan is more than enough. If you go to the doctor’s often and take a lot of medication, then you might want to consider changing plans.
Although the Bronze plan premium is cheap, seeing a doctor (outpatient services) would still cost $75, seeing a specialist would cost $105, and a blood test would cost $40. After your first three visits, you would pay out-of-pocket for all doctor visits until you meet the $7000 deductible. After the deductible is met, you would then be able to use the plan benefits. You would also pay the costs of an ambulance, surgery, and hospitalization out of your own pocket until you meet the deductible.
In comparison, although the Gold plan is a bit more expensive, seeing a doctor would only cost $25, a specialist visit would cost $55, and a blood test would cost $35, with no limit on the number of visits. A visit to the emergency room would cost around $325, and surgery or hospitalization would cost 20% of the total payment.
Looking back at 2017, if you feel that you’ve spent too much out of your own pocket on medical expenses, you should take advantage of Open Enrollment period (November 1, 2017 to January 31, 2018)! Contact a professional KCAL health insurance agent today and they can help you customize a health plan that is suitable for you and your insurance needs!
For affordable prices, check out these locations here: Orange County, San Bernardino, Chino, Riverside, etc. and all those located on the east of the 57 freeway. For residents living in those areas, some insurance companies’ Bronze plan premiums can reach as low as $1! Under certain circumstances, some Gold plans are even cheaper than Silver plans. Contact a health insurance agent at KCAL immediately for an opportunity to watch your premiums get lower and lower!
Real life scenario: Mr. Chang and his wife live in Hacienda Heights, which is located in Los Angeles County. Their annual household income is about $40,000. Kaiser’s Bronze plan is only $2 a month, and their Silver PPO plan is about $417.35 a month. Mr. Chang never goes to the doctor and his health is in pretty good condition. Let’s do some quick calculations! If he only pays $2 a month for the Bronze plan, he would save $417.35 – $2 = $415.35 a month, saving around $4984.20 in a year. If he gets a cold or feels a little bit uncomfortable, he could use Kaiser’s virtual doctor in which he can consult a doctor at no cost at the comfort of his home through the Kaiser app.
As a Kaiser member, you are able to use it an unlimited amount of times! If you really need to go to the hospital to see a doctor in person, then that’s when you would start paying outpatient fees.
2) Did your health/medical condition change?
If you or anyone in your family is expecting a substantial increase in the use of medical services in the upcoming year, such as planning a pregnancy, expecting to go through a surgery or treatment, then you should reevaluate your current health plan during Covered California’s Open Enrollment period and find a plan that meets your medical needs!
For those with a high demand for medical services, you may want to consider upgrading your plan to the Platinum plan. Although its premium is the highest, the annual out-of-pocket maximum is only $3,350, and any outpatient services, lab tests, and medication costs are cheaper than other plans. Overall, the costs are much more affordable. You might also want to consider whether an HMO or PPO plan is better for you.
Just remember that not only should you take the premium into consideration, but you should also think about your medical needs as well! In the end, the plan with a higher premium may help you save more and it might even come out as the more affordable option!
| Primary Care Physician | Specialist | Advantages | Disadvantages | Who is it suitable for? | |
|---|---|---|---|---|---|
| HMO | You must designate a PCP | Must get a referral from your PCP to see a specialist | More inexpensive, won’t need to worry about specialists being out of network or not in the contract | Limited choice of medical networks | Those with a regular family doctor, those with good medical condition |
| PPO | You don’t need to choose a PCP, insurance company will recommend a PCP for you for emergency use | Don’t need a referral from you PCP to see a specialist | See doctors all over the country even outside of your medical network | Premiums are higher, and you would need to confirm if clinics, labs, hospitals, and other medical centers are contracted | Those who are familiar with the American medical system, those who need to see all kinds of doctors, and those who are often out of state |
For affordable prices, check out these locations here: Orange County, San Bernardino, Chino, Riverside, etc. and all those located on the east of the 57 freeway. For residents living in those areas, some insurance companies’ Bronze plan premiums can reach as low as $1! Under certain circumstances, some Gold plans are even cheaper than Silver plans. Contact a health insurance agent at KCAL immediately for an opportunity to watch your premiums get lower and lower!
Real life scenario: A family of four living in Irvine (age 40, 38, 10, and 8) has an annual household income of about $50,000. The mother contacts KCAL as she finds out that she is going to have to go through surgery next year. They find out that the premium for Kaiser’s Gold plan is only $351 and the Silver is around $410. After switching to the Gold plan, not only did they save on premiums, but they also saved on inpatient/hospitalization costs in which they only have to spend 20% of the total cost without having to meet the deductible of several thousand dollars.
3) Does your doctor accept your insurance?
Every health plan has its own medical network. If the doctor you want to see is not in that medical network, then you would have to spend more on medical expenses out of your own pocket. The contract between a medical network and the doctor must be updated every year which makes it possible that changes were made. With that being said, it’s important to remember to confirm with your doctor and medical center that they still accept your insurance for the following year during Covered California’s Open Enrollment period. Had enough of going out of network to see the doctor you want to see? Maybe you should consider Kaiser! You won’t have to worry about contracts and fees for doctor visits because they are all a part of the same contracted benefits plan. This can help you save a year’s worth of troubles!
4) Did your household income or household size change?
Your annual household income and your household size are factors in determining what benefits you would receive. When your income increases or household size decreases, you might receive fewer subsidies from the government. If your income decreases or your household size increases, you may receive even more subsidies from the government or qualify for Medi-Cal.
- Children graduating from college and starting to file their own taxes?
- Expecting a new child in your family?
- Parents turning 65 and transferring to Medicare?
If any of these apply to you, you should know that these are all big life changes that affect your health insurance. Make sure to contact an insurance agent during Open Enrollment period to update your information. This can have a direct impact on the amount of subsidies and benefits you receive from the government!
Whether it’s your first time purchasing health insurance or changing plans because it’s too expensive, you need to make a smart decision about your health insurance. It is recommended to consult with a professional health agent especially if you have a certain doctor you like to see or a medical center that you like to go to. If you’d like your coverage to be effective on January 1, 2018, then you must enroll into health insurance by December 15. You still have 30 days! Take advantage of this time and take action ASAP!
KCAL Insurance Agency is a certified Covered California health insurance agency—your number one choice in health insurance! Contact us now at 1-800-681-8288 to speak with a health insurance representative directly!