Individual Health Insurance California
Do I Need Individual Health Insurance?
The Obamacare mandate requires that most people obtain medical insurance coverage. If you are not already enrolled in a health plan that meets the Affordable Care Act minimum essential benefits requirements, you may need to switch plans.
- You are self-employed.
- Your employer does not offer group plans.
- You are enrolled in a group plan, but it does not cover your spouse or dependents.
- You are enrolled in a health plan, but the premiums are too high.You are enrolled in a health plan, but your benefit needs have changed
Pros and Cons of Individual Health Insurance
For some, personal health insurance is the only way to meet ACA requirements, If you have the option of group health insurance, personal health insurance plans may still be the better option. It all comes down to which plan best meets your needs.
Individual health insurance has several benefits, such as:
More control
Individual plans allow you to choose from a wider plan selection than just the ones your employer presents to you. You can find a more customized solution that includes what you need and excludes what you don’t.
Flexibility
Personal health insurance is not tied to your employment. This can be useful if you are concerned about job loss or changing positions. You can even use it to “close a gap” between an insufficient employer-provided plan and your healthcare needs.
Choice of insurer
Individual plans allow you to choose from a wider plan selection than just the ones your employer presents to you. You can find a more customized solution that includes what you need and excludes what you don’t.
On the other hand, individual health insurance also has some downsides:
Higher costs
Often, a group plan is partially paid for by the employer and has lower premiums in the first place. Without these savings, individual plans can be slightly more expensive.
Pre-existing condition coverage
Individual plans may charge additional fees or lack coverage if you have a pre-existing condition. Potential fees or limited coverage for pre-existing conditions.
Types of Individual Health Insurance
Individual health plans vary in how they are structured and how much they pay for your health costs. Under the ACA, all health plans must meet certain minimum essential coverage, meaning that no one can be denied during the Open Enrollment Period for any pre-existing medical conditions.
Health plans are classified under five major categories to make comparing them easier. The categories are divided according to the percentage of health care costs they pay, and they include the following:
Platinum
Plan pays 90% of your health costs. You pay 10%.
Gold
Plan pays 80% of your health costs. You pay 20%.
Silver
Plan pays 70% of your health costs. You pay 30%.
Bronze
Plan pays 60% of your health costs. You pay 40%.
With these categories, you’ll also find different structures:
Choosing the Plan That’s Right for You
Choosing a personal health insurance plan that best fits your needs depends on a few different factors. Consider the following aspects and determine how they’ll affect your plan:
Provider eligibility and choice
Want to keep your current doctor? Make sure they’re in-network first. Also, make sure you’re comfortable with the providers covered under the plan.
Medication eligibility
Medication coverage can vary widely by form, brand and prior approval requirements. If you take regular medications, you’ll want to make sure they’re covered appropriately.
Premiums vs. out-of-pocket costs
If you frequently visit the doctor, lower copayments can be easier to manage but will have higher premiums. Alternatively, if you rarely see a doctor, lower premiums and higher out-of-pocket costs might be a good choice.
Network resources:
If you don't have much patience for phone calls, reimbursements, and paperwork, you may want to prioritize a provider with exceptional customer service, streamlined processes, and minimal requirements on your end.
Buying California Individual Health Insurance
Before purchasing personal health insurance, you need to think about your health care needs and budget. Then, compare various plans to find the most suitable fit. Here are some questions you need to consider.
- How is the plan structured?
- Which providers are in the network?
- What is covered by the plan?
- How much out-of-pocket costs do you pay?
- How much does the plan pay for your coverage?
OBAMA CARE
Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.
CA HEALTH EXCHANGE
Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.
INCOME GUIDELINES
Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.
ONLINE SERVICES
Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.