Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
IEHP appears to have very competitive rates for the Bronze and Silver metal tier health plans. They are less competitive at the Gold and Platinum levels. IEHP is the primary Medi-Cal managed care plan for the 2 counties. With the end of public health emergency, many Medi-Cal beneficiaries may no longer be eligible and will be transitioned to Covered California private health plans with the health insurance subsidies.
Silver 73, 87, and 94 health plans, available through Covered California based on household income, have no medical deductible. That does not mean you escape any patient responsibility for health care services subject to coinsurance. With the enhanced Silver plans, you go straight into the coinsurance percentage for inpatient hospitalization and skilled nursing facility stays because there is no medical deductible.
There are a couple of different models of the deductible insurance plans. All of the designs require the individual to meet a deductible between $1,000 to $2,000. The plan’s deductible are health care expenses you must pay before the deductible insurance is triggered. Also with the models are two different maximum benefits of either $4,000 or $6,000. In other words, the plan will cover either $4,000 or $6,000 in health care expenses in a calendar year.
PPO and EPO plans generally have a larger network of hospitals and medical groups. They will include popular providers such as Cedars Sinai, Hoag, Providence, Sutter, and UC hospitals and medical group. The members of PPO and EPO plans can travel great distances to see their favorite specialist.
The cost of major surgeries or cancer treatment can easily top out at $100,000 or more. The health insurance with a maximum out-of-pocket amount limits your liability so you do not have to liquidate your assets to pay the doctor and hospital bills. Health insurance protects your assets.
Loss of coverage is a Qualifying Life Event for a Special Enrollment Period into an individual and family plan. The problem for many people is the timing of the enrollment and the effective date of coverage. You must apply for an individual and family plan in the month prior to the effective date. Individual and family plans – in most instances – always become effective on the 1st of the month. There is no retroactive effective date offered.
Even though Oscar was in California for 7 years, they never develop strong name or brand recognition for their health plans. I was always surprised when a client would curse one of the big health plans, then turn around and enroll with the same health plan. I suppose it was better to deal with the devil you know. Relative to the other carriers, Oscar offered a competitive EPO health plan product that worked as advertised.
Health insurance is absurdly expensive. When you retire, there is strong impetus to conserve money. Consequently, you will be looking at health insurance options that minimize monthly costs. Fortunately, there are a variety of combinations of health insurance options to reduce the monthly premiums.
There are non-standard benefit design health plans offered by carriers off-exchange. You cannot enroll in a non-standard benefit design plan through Covered California. The off-exchange non-standard benefit design plans are usually in the Bronze and Silver metal tier categories. There are more High Deductible Health Plans (HDHP) that are health savings account compatible offered off-exchange.
Blue Shield PPO members can schedule a visit by calling the Blue Shield Nurse Hotline or contacting Dispatchealth directly via website or telephone. Blue Shield HMO members must call their Primary Care Physician for a referral for an in-home visit to treat a medical condition. In-home visits are grouped into 5-hour windows corresponding to morning, afternoon or evening. Appointments can be as early as 7 AM or as late as 10 PM, sometimes on the same day as the request. Care is available in English and Spanish.
