Covered California finally released the health insurance premium rates on October 11! Individuals can start finding out how much their premiums will cost and how much subsidies they will receive for 2018. There are many changes in the 2018 individual healthcare market and important action needs to be taken, so we’re here to break it down for you in five parts!

1) Do you qualify for subsidies? $1 premiums are not a joke!

federal poverty levelYou might qualify for subsidies based on your annual household income. For example, for a family of three, and if your reported annual income is within $28,181 – $51,050, or if you’re single with an annual income of $16,644 – $30,150, then you will be able to receive  subsidies.

How much is the subsidy?

For Mr. Wang who is 45, single, and has an income of $20,000, living in Rowland Heights, purchasing a Kaiser Bronze 60 HMO plan would only cost a premium of $1, since he is receiving federal assistance of $280 worth of subsidies. Last year, he paid at least $50 a month for this same plan.

For Mr. Zhang’s family of four living in Hacienda Heights, ages 40, 39, 10, and 8 with an annual household income of $40,000, they would only have to pay a premium of $4. With Kaiser’s Bronze 60 plan, last year would cost around $81. If they upgrade to the Silver plan, the premium would only be about $150.

**Refer to the following chart to see which category you fall under and which subsidies you are eligible for

2) You still have many options with affordable premiums and quality benefits

Although Anthem Blue Cross is withdrawing from Southern California’s health insurance marketplace, residents still have five more insurance companies they can choose from. In 2018, there are three highly recommended health insurance companies in Southern California: Kaiser Permanente HMO, HealthNet HMO, and Blue Shield HMO (not in any particular order).

Among these options, Kaiser’s Bronze HMO plan is the highlight of the year! In Los Angeles County, premiums are as low as $1-2! ($10 in the Orange County area) As an example, in a family of three, ages 55, 50, 20 with an annual income of $60,000, they would only have to pay $30 a month with Kaiser’s Bronze Plan.

Kaiser is the only five-star rated medical center in Covered California and its one stop shop gets a lot of praise in the Chinese community because they are more used to this style of medical service. Its low prices and quality service are what people love! (Click here to get more information about Kaiser’s health insurance!)

HealthNet and Blue Shield also have their advantages. Since they work with Allied Pacific, finding a Chinese speaking doctor won’t be an issue. Their prices are also very cost-efficient. The popular plans among the Chinese community include Silver 94 and Silver 87. As an example, for a couple living in Monterey Park, aged 62 and 59 with an income of $24,000, the premium for purchasing a Silver 94 plan for Blue Shield would be $80 and HealthNet would be $79. For a single 45-year old individual living in Rowland Heights, the premium would be around $80 for the Silver 87 plan.

3) Middle to high class income families face substantial premium increase

For higher middle class income families, if you are not eligible to receive federal subsidies, or feel that the price increase is too much, especially for those who have PPO plans, you may want to consider switching plans.

See below for a comparison of various Silver plan premiums for someone who is age 25 versus someone who is age 40.

Trying to decrease your premium? The best way is to change plans! Whether it’s downgrading a level and going from Silver to Bronze or changing from PPO to HMO. For families who have an annual income that is on the borderline between receiving federal subsidies and not receiving federal subsidies, please consult a health insurance agent at KCAL immediately! They may have strategies to help you adjust your reported annual income on your tax return and help you apply for government assisted health insurance.

4) Take advantage of open enrollment – the sooner you apply, the more you save!

Open enrollment period is from November 1, 2017 to January 31, 2018. If you would like your new insurance policy to become effective on January 1, 2018, then you must apply by December 15.

Take action now! Our certified health insurance agents at KCAL are ready to assist you, as we have already started providing clients with plan renewals and plan options.

5) Get enrolled and get benefits!

Wow~ didn’t expect the benefits to get even better in 2018, did you? The most noticeable benefits are the annual out-of-pocket maximum, outpatient fees, and medication costs—they’ve all been reduced!

For the Silver 94 plan, the copay for seeing your primary care physician is $5, and the copay for seeing a specialist is only $8! The annual out-of-pocket maximum for individuals is decreasing from $2,350 to $1,000 which means that after spending $1,000 on medical costs, you won’t have to spend on medical expenses for the rest of the year. The annual out-of-pocket limit for the Gold plan is reduced from $6,750 to $6,000 and the cost of emergency care and doctor visits will be reduced as well. The annual out-of-pocket limit for the Platinum plan is reduced from $4,000 to $3,350, and specialist visits will be reduced as well.

If you fall into one of the two following circumstances, make sure to contact your health insurance agent as soon as possible:

1) If your health insurance company is withdrawing and your plan is terminating… 

Starting on January 1, 2018, Anthem Blue Cross is withdrawing from certain regions of the state and will only offer plans in three regions of Northern California, which includes Region 1 (Redding County/Far North), Region 7 (Santa Clara County), and Region 10 (Stockton/Modesto County). If you are a member of Anthem Blue Cross, your current individual health plan will be automatically cancelled by the end of 2017. If you are under Covered California’s on-exchange health plan and don’t take any kind of action, your current plan will auto map to the lowest cost plan within the same metal tier.  If your individual health plan is a grandfathered plan, this change will not affect you.

Blue Shield’s Bronze 5550 PPO plans, Silver Seven 3750 PPO plans, and several IFP Grandfathered plans will no longer be available.

2) Waiting for your SSN or green card so you can change plans? What can you do if you’re currently in the process of obtaining citizenship?

Contact KCAL Insurance as soon as possible and ask about our MYT health plan! Not having citizenship won’t be a restriction. Please note: you may only enroll from November 1, 2017 – January 31, 2018. Contact us immediately to learn more about our MYT health plan!

Have any more health insurance related questions? Contact your professional, certified health insurance agent for more information!

Contact us now at 888-851-5889 to speak with a representative immediately! KCAL Insurance Agency, your number one healthcare option!