We are an independent agency contracted with Covered California (On Exchange) and direct to all the carriers (Off Exchange). There are no broker fees for our services and we are a full-service (year-round) agency. We have been in business since 2002.
1-There are (4) Metal Tier plans to choose from in California. Bronze-Silver-Gold-Platinum. Each metal tier must be identical from carriers selling their plan in your rating zip code. What that means is Bronze is Bronze regardless of which carrier you buy it from. What is different is the premium and the network of doctors each carrier has contacted. Therefore, if you doctor or hospital is important to you it is VERY important that you contact a broker to confirm they are in-network. Most carriers in the California market do NOT have out of network benefits. Thus, if you go to an out of network provider there may be NO coverage.
Below is a summary of the (4) metal plans that are available. When you see a percentage sign (co-insurance) the deductible applies before the co-insurance applies and a dollar sign is a co-pay and the deductible is waived.
2-Should I shop for a plan in the California Insurance Exchange (Covered California)?
There are (2) insurance markets in 2015 for individual and family coverage. “On-Exchange” called Covered California and “Off-Exchange” is direct to the carrier for sale in your rating area. The metal tier benefits are the same by carrier. What this means is Bronze benefits or Silver benefits are the same from each carrier. The difference is premium. Premiums are calculated by age, zip and carrier’s contracts (doctors and hospitals) that each carrier has contracted-this is called the “NETWORK”. If there is no contact the provider is considered “Out of Network”.
If you were subsidy eligible, we would enroll you through the Covered California exchange to receive a subsidy or tax credit. The subsidy is deducted from the list price of the plan and you are billed the adjusted premium after the subsidy is applied.
**There is a difference with some carriers’ in networks if you buy a metal tier via Covered CA or direct to the carrier “Off Exchange”. In other words your doctor may be in network with Blue Shield “Off” exchange but not in network buying the same plan through Covered California. You should contact our agency to research this very important subject.
3-What carriers are contracted with Covered California?
In California there are (4) carriers that are selling plans that a subscriber can choose. Anthem Blue Cross, Blue Shield of CA, HealthNet and Kaiser offer plans in the (4) metal tiers to choose from.
There are (3) plan designs referred to as PPO, EPO and HMO. Depending on your county, each carrier has contacted with a different network.
An EPO is an Exclusive Provider Network and is an In-Network (ONLY) large network, which has NO out of network benefits. In Southern California Anthem is an EPO and primary contracted with the University of CA network groups. Some examples are UCLA, UCI and UCSD. If you doctor or hospital of choice is part of the “UC” system, you would probably want to consider Anthem.
A PPO is a Preferred Provider Organization and has traditional “In” and “Out” of network benefits. Please note that benefits are reduced (but still there) by going out of network. Therefore, it is advisable to stay in the network to reduce a members out of pocket exposure.
A HMO is a Health Maintenance Organization. It is a smaller network that the member must stay in their contacted network. There are no out of network benefits. Your primary physician (PCP) is the member’s first point of contact and he/she will authorize a referral to a specialist when appropriate. The member must to their PCP first to get a one-time referral for a specialist.
As you can see there are several variables to purchasing the right plan. There are no broker fees for our services to help you make the right choice. Call us today for help at 877-840-0554 or click on the “Get a Quote” below to get started.