Open Enrollment for 2016 is: 11-1-15 through 1-31-2016
As was the case in prior years, there continues to be Four Metal Tiered Benefit Plans in California.
-Bronze -Silver -Gold -Platinum
In the Individual and Family Market, all metal tiers by metal design must be consistent by carrier. In other words, a Silver level plan is the same Silver level plan regardless of which carrier you purchase.
What is different in the contract of providers “in-network” the each carrier’s plans. Therefore, along with price it is very important to check with your broker which carrier has your doctor contracted or “covered”. Failing to do so could result in NO benefits (EPO) or out of network benefits. Out of network benefits are typically reduced to 50/50.
List below is a basic summary of the four metal tiers for sale in the Individual and Family market in 2016.
The metal tiers plans are the same or “mirror” each other inside “On” the Covered California Exchange or outside the exchange called “Off” Exchange. Thus, the plan designs and their price are identical. What is different is that if you are subsidy eligible you must purchase your plan through the Covered California Exchange. We are a certified Storefront as well as agency and are here to help. There is no price difference when purchasing a Covered California plan through a broker. Although, we offer personalized service and have a personal relationship with our clients-you will never be transferred and we answer every in-bound call to our office in Huntington Beach, California. We have been in business for 15 years.
Subsidies in Covered California begin at $16,244. If you earn less than that per year you must enroll on Medi-Cal. We cannot enroll a person in Medi-Cal. If you income (single) is between $16,244 and $47,080 you may be eligible for a subsidy to offset your premium.
Subsidies are based of total household adjusted gross income (AGI) on your tax return and family size. We are here to help you calculate if you are subsidy eligible. It is important to get this correct as the IRS will audit every subsidy application and you will owe the money back if you calculate it incorrectly. We are here to help you avoid this situation.