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Basic Insurance Plan Benefits

  • A basic health insurance plan designed for individuals under the age of 30
  • First three non-preventive visits are free, after the annual out-of-pocket maximum is met, the insurance will cover all necessary services
  • Individual annual out-of-pocket maximum: $7,900
  • Family annual out-of-pocket maximum: $15,800
  • Free annual health check-up
  • Premium is less than $100 per month
  • Click here for more details about this plan
  • Primary care visit: $75*
  • Specialist visit: $105*
  • Laboratory tests: $40
  • Outpatient surgery and inpatient hospitalization, full cost until deductible is met
  • Individual annual out-of-pocket maximum: $7,550
  • Click here for more details about this plan

(*First three visits each year are not subject to deductible)

  • Primary care visit: $40
  • Specialist visit: $80
  • Laboratory tests: $35
  • After deductible is met, inpatient hospitalization is 20% of total cost
  • Outpatient surgery: 20% of total cost
  • Individual annual out-of-pocket maximum: $7,550
  • Click here for more details about this plan
  • Primary care visit: $30
  • Specialist visit: $55
  • Laboratory tests: $35
  • Outpatient surgery & inpatient hospitalization: 20% of total cost
  • Individual annual out-of-pocket maximum $7,200
  • Click here for more details about this plan
  • Primary care visit: $15
  • Specialist visit: $30
  • Laboratory tests: $15
  • Outpatient surgery & inpatient hospitalization: 10% of total cost 
  • Individual annual out-of-pocket maximum: $3,350
  • Click here for more details about this plan

Low Income Individual and Family Insurance Plan Benefits

  • Primary care visit: $5
  • Specialist visit: $8
  • Laboratory tests: $8
  • After deductible is met, inpatient hospitalization is 10% of total cost
  • Outpatient surgery: 10% of total cost
  • Individual annual out-of-pocket maximum: $1,000
  • Click here for more details about this plan
  • Primary care visit: $15
  • Specialist visit: $25
  • Laboratory tests: $15
  • After deductible is met, inpatient hospitalization is 15% of total cost
  • Outpatient surgery: 15% of total cost
  • Individual annual out-of-pocket maximum: $2,600
  • Click here for more details about this plan
  • Primary care visit: $35
  • Specialist visit: $75
  • Laboratory tests: $35
  • After deductible is met, inpatient hospitalization is 20% of total cost
  • Outpatient surgery: 20% of total cost
  • Individual annual out-of-pocket maximum: $6,300
  • Click here for more details about this plan
  • Primary care visit: $40
  • Specialist visit: $80
  • Laboratory tests: $35
  • After deductible is met, inpatient hospitalization is 20% of total cost
  • Outpatient surgery: 20% of total cost
  • Individual annual out-of-pocket maximum: $7,550
  • Click here for more details about this plan

No. In 2019, the Trump Administration repealed the health insurance individual mandate, removing the fine for not having health insurance.

If you apply for health insurance through Covered California, you will still have the opportunity to apply and qualify for subsidies. The Open Enrollment Period for purchasing health insurance in 2019 starts from October 15, 2018 and ends on January 15, 2019. If you would like your policy to become effective on January 1, 2019, then you will need to enroll and submit your application by December 15, 2018.

During this Open Enrollment Period, you can also update or change your health plan if you would like to do so. If you miss this time period, you will not be able to purchase health insurance at any point for the rest of the year, unless you qualify for special enrollment.

Covered California rates for 2019 increased by an average of 8.7%. Some insurance companies even rose more than 50%. If you qualify for subsidies, then you can purchase health insurance through Covered California. Some plans have premiums as low as $1 a month.

If you are currently using a PPO plan, you might want to consider switching to HMO to save more on premiums. Downgrading your plan is another way to save. If you have a Platinum plan and find it too expensive, you can consider downgrading to the Gold or Silver plans.

You can also open an IRA to reduce the taxable income so that when you apply for government subsidies you will have lower premiums and get better benefits.

The 2019 Open Enrollment Period starts on October 15, 2018 and ends on January 15, 2019.

If you would like your insurance policy to become effective on January 1, 2019, then you must apply by December 15, 2018. If you apply by January 15, 2019, then your new policy will become effective on February 1, 2019.

Although there is no penalty for not having health insurance for 2019, the only opportunity for you to enroll in health insurance is from October 15, 2018 to January 15, 2019.

If you miss this open enrollment period, you will not be able to purchase health insurance unless you qualify for special enrollment, in which you would have to apply for health insurance within 60 days of your qualifying life event which include:

1. A child is born, adopted or received into foster care; your child is placed into foster care or is up for adoption

2. Loss of employer-sponsored coverage, or your COBRA coverage is exhausted (Note: Not paying your COBRA premium is not considered loss of coverage)

3. Loss of Medi-Cal coverage

4. Moved to California from out of state or moved within California and gained access to at least one new Covered California health insurance plan

Because you do not have a SSN, you won’t be able to purchase general health insurance used by United States citizens. Basic travel insurance also won’t be able to cover pre-existing conditions such as diabetes, high blood pressure, pregnancy, and more. However, we recommend taking a look at our “MYT” health insurance. (Click here for more information.)

 

Covered California and the IRS are connected in the sense where Covered California uses the household income and household size on the 1040 tax form to calculate health insurance premiums and check for eligible federal subsidies for the applicant.

Based on your annual household income, you may qualify for federal subsidies in the form of Medi-Cal, premium assistance, or cost-sharing reductions.

As long as you are a resident with a taxable income, you are required to have health insurance whether it’s through your employer, Covered California, etc. If you do not, you will be penalized and fined. To determine whether you qualify for premium assistance, please refer to this chart

To find your adjusted gross income, you take a look at Line 37 on this year’s Form 1040, Line 21 on Form 1040A, or Line 4 on Form 1040EZ.

If you have your paycheck statement, you can use it as proof of income. If you do not have any valid documents, you can ask your accountant or employer to provide you with a signed proof of income statement.

If you want to enroll for health insurance with subsidies during open enrollment, you cannot cancel your Medi-Cal coverage.

If you do not need subsidies, you can cancel your Medi-Cal coverage and purchase health insurance without subsidies during open enrollment.

You will need to provide proof of income to the county office where you reside to cancel your Medi-Cal coverage before you can apply for general health insurance.

PPO premiums continue to increase as it has done so in the past few years. If your health is in good condition and you do not expect to go to the doctor’s often, then you can consider switching to an HMO or EPO plan.

You can also open an IRA to reduce the taxable income so that when you apply for government subsidies you will have lower premiums and get better benefits.

If your doctor is not contracted with your current insurance company, then you can switch to an insurance company that your doctor is in contract with.

If your primary care physician only accepts group health insurance and you are self-employed, or a 1099 employer, feel free to contact KCAL to see what your options are.

Since the benefits would be the same, one way to help you choose the right insurance company is based on the quality of service and the size of the medical network.

If you want to be able to see a doctor easily and don’t want to delay treatment due to conflicts with your medical network, then Kaiser is your best option. Its comprehensive medical system and latest medical equipment make it easy to see a doctor. At Kaiser, you would be able to see the doctor, pick up any necessary medication, get your blood tested, and many more services all done in the same building without having to go to different facilities. Its one-stop shop type of service is not only convenient, but it also saves a lot of time. It creates a sense of comfort and warmth, and makes you feel comfortable and at ease.

If the company you work at offers you and your family group health insurance, you won’t be able to purchase insurance with government subsidies for you and your family. As long as the company-provided health insurance is considered affordable and meets certain standards, then you won’t qualify for subsidies.

If you and your family are applying for subsidies when your company offers group health insurance to you and your family, then your subsidies will be returned to the government.

However, if the out-of-pocket amount you have to pay for the employer-sponsored plan’s premium (not including the premium your family pays) is 9.5% higher than your annual household income, then you and your family can apply for government subsidies for health insurance after submitting necessary documentation.