California Health Care

The Golden State is getting a pleasant surprise in 2021. Covered California rates are going up 0.6% on average and the plan benefits are not changing very much.

The out-of-pocket maximum is going up from $7,800 to $8,200 on the Bronze, Silver and Gold Plans. For Bronze and Silver, there are no other benefit changes for next year.

On the Gold Plans, there are a couple more changes beyond the out-of-pocket maximum going up $400. Doctor Visits and Urgent Care are both going up $5, from $30 per visit to $35 per visit. For Gold Plans that have a copay for Imaging (including CT, PET Scans, and MRI’s), the copay is dropping from $275 down to $150. For Gold Plans that require a percentage payment for Imaging, that amount will remain at 20%.

For the Silver 87 Plans, there is one small change. The out-of-pocket maximum is going up $150, from $2,700 up to $2,850.

In 2021, consumers can look forward to small rate changes and minimal benefit changes. Also, if Californians switch plans to the lowest p...

How much can you expect to spend on health care during your retirement years? The answer depends on your overall health and your life expectancy. One study found that the average household can expect to spend around $122,000 on health care costs for the remainder of their lifetimes from age 70 on. Households in the top 5% of spenders can expect to pay around $330,000 in health care costs over the rest of their lives.

Health care costs are a significant source of concern and stress for people about to enter retirement and those already in retirement. According to a Harris Poll, nearly three-quarters of adults stated that they were concerned about health care costs spiraling out-of-control while they are in retirement. Almost two-thirds of adults said they were “terrified” about what the cost of health care could do to their retirement savings.

Although you can’t predict the future with 100% accuracy, you can take steps to plan for your retirement years and find ways to cover the...

The Affordable Care Act significantly reduced the number of uninsured people in California. In 2013, the uninsured rate in the state was 16 percent, but that figure dropped to nine percent in 2015. That means there are still nearly three million people in the state without insurance. Cost is one of the top reasons people remain without health coverage. In 2018, premiums in California increased an average of 12.5 percent, and they are expected rise 8.7 percent next year.

Although price can be a barrier, health insurance is an important investment. If you get sick or have an unexpected accident, you will need to pay for that completely out-of-pocket without insurance. A three-day stay in the hospital can cost approximately $30,000. Most people do not have that kind of money on-hand, which means they will end up carrying a significant amount of medical debt.

Other uninsured people do not sign up coverage because they are intimidated by the process, but getting insurance through Covered...

The Affordable Care Act (ACA) has made health insurance more accessible to families and individuals across the United States, including those in California. In 2018, 93 percent of Californians have coverage, indicating greater health outcomes for the state’s residents overall. However, this number still leaves seven percent of Californians — around three million individuals — uninsured.

California’s remaining uninsured lack coverage for many reasons. Some are ineligible for coverage due to their immigration status. Others come from low-income households where insurance may not be a top priority.

Some individuals may actually qualify for financial assistance but remain uninsured because they either have trouble with the enrollment process or don’t know they qualify for aid. And in some cases, California’s high cost of living, especially with regards to housing, may make insurance premiums difficult to afford even with financial assistance.

Despite these barriers, low-income ind...

California is home to approximately 10 million immigrants, accounting for about 27 percent of the state’s total population. No matter where you are born, access to health care coverage is essential. Some people have insurance through their employer, but many others need to figure out how to obtain coverage on their own. The process can be confusing. As an immigrant or green card holder, are the rules different for you? Do you qualify for healthcare insurance in California? Health for California Insurance Center makes it easy to understand your options and obtain the coverage you need. Learn the ins and outs of health insurance immigrants and green card holders so you can get covered.

Documented immigrants who live in California have access to health insurance. If you are unsure of your exact status, here are some of the immigrant groups who can apply for health care coverage:

If you are a documented immigrant, you can apply for Covered California coverage through the Health for C...

Obamacare requires that most Californians enroll in a health insurance plan or face tax penalties. Many Californians buy their plans through Covered California, but the state-run health insurance exchange isn’t the only option. You can purchase health insurance outside the marketplace.

People who qualify for subsidies benefit a lot from buying through the exchange. But if you’re not eligible for lower premiums on a health plan because your income is above 400-percent FPL, selecting health insurance outside the marketplace is logical.

The primary thing you should know about enrolling through the private market is that you must still sign up during the open enrollment period. In 2014, all private insurance carriers in the market adopted the open enrollment period of Obamacare. Outside this period, you’ll only find short-term plans that don’t meet the minimum essential requirements and won’t protect you from tax penalties.

There are many reasons to shop for health insurance outside...

Healthcare in the United States has seen a lot of changes in the past few years, with prices for coverage fluctuating dramatically and the very platform for healthcare hanging in the political balance. This issue comes at a time when our country is still recovering from a devastating economic recession, and financial uncertainty and fickle premium costs are prodding many Californians to look for alternatives to health care coverage.

Many questions remain unclear to the average buyer. Are there penalties for not having health insurance? Is health insurance a requirement in California? If I can’t afford health insurance in California, or I don’t want to pay for health insurance, what are my options?

In this article, we will explain the risks of not having health insurance in California and other places, as well as how to better understand the healthcare system so that you won’t have to go without it.

Despite the number of Americans without health insurance dropping from 44 million to...

by John Hansen

What’s an EPO? That was the big question for many consumers during the 2017 Open Enrollment Period in California. It made consumers uneasy, and it caused many to switch from Anthem Blue Cross Covered California to Blue Shield Covered California.

Yes, there is a difference. Anthem stopped offering out-of-network coverage. And, for many Californian’s who want choice, they felt they would be limited by this.

Whether you go with Anthem or Blue Shield, it most often makes the most sense to stay in network. Your out-of-pocket costs remain so much lower when you stay in-network.

Anthem was losing money on their out-of-network coverage offered by their PPO’s so they made a gutsy move to switch all their individual and family plans over to EPO’s and stop offering out-of-network coverage. But they may have made a mistake.

Blue Shield of California was facing the same challenges with their PPO products, but they chose to keep offering out-of-network coverage. This was a huge ri...

by John Hansen

The Affordable Care Act (ACA) was intended to be just that…affordable. However, many are arguing that Obamacare has really just caused rates to rise. For some who are receiving the benefits of expanded Medicaid or large subsidies through the exchanges, health insurance has become attainable and/or has become more affordable. However, for many Americans prices went up.

Here are a few possible solutions:

In a meeting of leading brokers offering health insurance in California, the question was asked, “How can we get rates to decrease?” The top answer from the room was to move more customers over to managed care models like Kaiser Permanente.

Jeff Smith, Blue Shield of CA Individual and Family Plan General Manager, said, “Kaiser has done a wonderful job of that.” Kaiser Permanente has put together an integrated system where the health insurance, the medical providers and the hospitals are all working together to improve health outcomes and keep prices low.

Smith added,...

by John Hansen

If people didn’t get sick, health care would be cheap, but it would also be unnecessary. As legislators are trying to deal with the issues surrounding health care in America, one of the key issues is how to deal with the incredibly high costs of servicing people with serious health conditions.

This is the primary concern of health insurance carriers. They need a healthy pool of members in order to stay in the black.

According to Jeff Smith, Blue Shield Covered California Individual and Family Plan General Manager, “A healthy pool means that 5% of members make up 90% of the costs”. When you have too many sick people in the pool, it’s upside down for the insurers and not sustainable.

It’s the top utilizers that are driving up the costs. High utilization of expensive surgeries, hospitalization and pricey prescription drugs makes it difficult to manage the costs of health care in America.

It’s actually a small percentage of the population that is driving up the costs...