Individual
Health Insurance California
Do I Need Individual Health Insurance?
- If you are self-employed or work for an employer that does not offer group health plans, you may need to obtain individual health insurance.
- You may also need individual health insurance if you are enrolled in a group plan that does not cover your spouse or dependents.
- Similarly, if your current health plan premiums are too high or your benefits needs have changed, you may need to shop for individual health insurance.
Need a Health Plan Now?
Medi-Cal ending?
Enroll in a new plan.
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Speak with a service center representative during our regular business hours.
619-925-8000
EMail us with any questions @ info@insurance800.com during or after our regular business hours
SHOP
It's possible that you may qualify for assistance in lowering your healthcare costs.
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.
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:
Health maintenance organization (HMO): HMOs (Health Maintenance Organizations) are an economical alternative to PPOs. They have smaller networks but are more affordable. Remember that a referral to a specialist is required after seeing your primary care physician.
Preferred provider organization (PPO): PPOs, or preferred provider organizations, typically come with a higher cost. However, the benefit is a larger network of providers and the ability to see one outside of the network. Additionally, you can see specialists without needing a referral.
Exclusive provider organization (EPO): EPO (Exclusive Provider Organizations) are a type of health insurance plan that combines features of both HMOs and PPOs. Like HMOs, EPOS have exclusive networks which make them less expensive than PPOs. However, unlike HMOs, you have the flexibility to make your own appointments with specialists, like with PPOs.
Point-of-Service Plan (POS): A POS plan is a type of health insurance that combines features of both PPO and HMO plans. It provides coverage for medical services received from healthcare providers outside the plan network but at a reduced level of benefits and discounts.
Choosing the Plan That’s Right for You
Find my Doctor or Hospital
Covered California has a feature to search for providers (doctors, hospitals, and children's dentists) while you shop for a health plan.
Search for providers by name and select up to five.
Click "View Plans" to see health plans available with green or red icons next to the provider's name to indicate if they're in the network.
Always confirm with providers whether they accept your chosen plan before enrolling.
Prescription Drugs
All health plans that are covered by Covered California provide prescription drug coverage.
Confirm that your prescription is covered with your health insurance company.
Prescription drugs are categorized into four tiers:
generic, preferred, non-preferred, and specialty.
Each drug tier has different prices for different metal tiers.
Each health plan has its own formulary, which is a list of medications that are covered.
Immigrants Lawfully Present
Under the Affordable Care Act, most immigrants qualify for health coverage, including the following:
Immigrants Not Lawfully Present
You may still be eligible for Medi-Cal coverage if you meet certain criteria:
How much will I get?
To determine the amount of financial assistance you are eligible for, estimate your household income for the current year. This should include the income of anyone you claim on your taxes.
Will I get financial help?
Yes! Higher income earners may now qualify for financial assistance, while lower income earners are receiving even greater savings than previously.
Documents to Confirm Eligibility
Income
Minimal Essential Coverage
Deceased Status
Non-Incarcerated
Social Security Number
Identity
Citizenship
Immigration Status
Penalty
Starting from January 1, 2020, California residents must do one of the following:
- Have the required health insurance coverage
- Obtain an exemption from the coverage requirement
- Pay a penalty when filing their state tax return
To avoid paying the penalty, you will need to have qualifying health coverage for each month starting on January 1, 2020 for:
- 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?
Many people are already covered by qualifying health insurance through:
- Employer-sponsored plans
- Coverage purchased through Covered California or directly from insurers
- Medicare
- Most Medicaid plans
Check out the exemption list for information about other exemptions that may apply to you.
Use the provided tool to estimate the penalty.
Q&A Health Insurance
Here is how the health insurance Bronze HSA plan with a high deductible works:
First, you must choose this specific plan (Bronze HSA) offered by your insurance provider. This plan typically has a higher deductible than others, so you must pay more out of pocket before your insurance coverage kicks in. However, this plan also comes with a Health Savings Account (HSA), allowing you to save pre-tax money and use it towards your medical expenses.
Once you have enrolled in the plan, you will need to ensure you understand its terms and conditions. This includes knowing what your deductible is, what services are covered, and what your out-of-pocket maximum is.
When you receive medical services, you will first be responsible for paying for them out of your HSA account until you meet your deductible. After that, your insurance coverage will kick in and cover some of the costs.
You must note that you can only use funds from your HSA account for eligible medical expenses. These include things like doctor visits, prescription medications, and medical procedures.
Overall, while the health insurance Bronze HSA plan with a high deductible may require you to pay more out of pocket initially, it can be a good option for those who want to save money on their health insurance premiums and have the ability to save money pre-tax for medical expenses.
A Health Savings Account (HSA)
A Health Savings Account (HSA) is a type of savings account that allows individuals in the United States to save money specifically for healthcare expenses. HSAs are generally used in conjunction with high-deductible health plans (HDHPs), which require individuals to pay many out-of-pocket expenses before their insurance coverage kicks in. By contributing to an HSA, individuals can set aside pre-tax dollars for their healthcare expenses, thereby reducing their taxable income and saving money on healthcare costs. In addition, funds in an HSA can be invested, allowing them to grow over time and provide a source of retirement income. Overall, an HSA is a valuable tool for individuals looking to manage their healthcare expenses and save money for the future.
HSA Health Savings Account for 1009 vs. W-2 employees
The HSA (Health Savings Account) is an account available to 1099 employees, while the W-2 employees have access to a different type of health account. While the HSA is a tax-advantaged account that allows individuals to save money on qualified medical expenses, there are some key differences between the two types of accounts. For example, the HSA is only available to individuals with a high-deductible health plan, whereas W-2 employees may have access to a traditional health plan with a lower deductible. Additionally, the HSA allows individuals to roll over unused funds yearly, while the W-2 employee’s health account may not have this option. Despite these differences, both types of accounts can be useful for individuals who want to save on medical expenses and plan for their healthcare needs.
HSA Health Savings Account is a separate account in the bank
A Health Savings Account or HSA is a special type of account that is separate from your regular bank account. It is designed to help you save money for medical expenses not covered by your health insurance. With an HSA, you can contribute pre-tax dollars to your account, which can then be used to pay for qualified medical expenses without incurring any taxes. This means that you can save money on your taxes while also saving money for future medical expenses. In addition, some employers may offer a matching contribution to your HSA, which can help you save even more. Overall, an HSA can be a valuable tool for managing your healthcare expenses and planning for the future. In order to be eligible for an HSA, you must have a high-deductible health plan (HDHP). An HDHP is a health insurance plan with a high deductible, meaning you will have to pay a certain amount of money out of pocket before your insurance coverage kicks in. The IRS sets the minimum deductible for an HDHP which can change from year to year. In addition to the minimum deductible, you need to be aware of maximum out-of-pocket limits.
One of the benefits of having an HSA is that you can use the funds in your account to pay for a wide range of medical expenses. This includes things like doctor’s visits, prescription medications, and medical procedures. In addition, you can also use your HSA funds to pay for certain types of insurance premiums, such as long-term care insurance. However, it’s important to note that an HSA, such as cosmetic procedures and over-the-counter medications, does not cover some expenses.
Another benefit of an HSA is that the funds in your account roll over from year to year. This means that if you don’t use all of the money in your HSA in one year, it will still be available for you to use in future years. This can be especially helpful if you have a chronic medical condition or if you anticipate needing expensive medical care in the future.
If you are considering opening an HSA, it’s important to do your research and find a plan that works for you. Some things to consider when choosing an HSA include the fees associated with the account, the investment options available, and the level of customer service the HSA provider provides. By finding the right HSA for your needs, you can save money on your healthcare expenses and plan for a healthier future.
HSA Health Savings Account tax benefits
A Health Savings Account (HSA) is a type of medical savings account that provides tax benefits. When you contribute to your HSA, you are able to deduct the amount from your taxable income. Additionally, the money you contribute earns interest tax-free, and when you use the funds for qualified medical expenses, you do not have to pay taxes on the withdrawals either. The tax benefits of an HSA can be a great way to save money while investing in your health. Moreover, having an HSA can help you prepare for unexpected medical expenses and be a valuable tool in managing your healthcare costs.
If you have any questions or concerns regarding our services or policies, please feel free to send us an email at info@insurance800.com. Our team is always ready and available to assist you in any way we can. We value our customers’ feedback and strive to provide the best possible service, so do not hesitate to reach out to us with any questions or comments you may have. Additionally, you can also check our website for more information about our company and the services we provide. We look forward to hearing from you soon!
Buying California Individual Health Insurance
- 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?
