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.
California Health Insurance
Posts specifically related to California health insurance, enrollment, premiums, plans, termination, Covered California, Medi-Cal, Medicare, small groups.
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.
Effective January 1, 2023, a new California law expands the definition of “dependent” for the purposes of enrollment in a Qualified Health Plan (QHP), to include a parent or stepparent of a qualified consumer. Rules for this benefit include that a dependent parent or stepparent must:
The one wildcard with outpatient services is the coinsurance. Coinsurance is a percentage of the invoiced services that the health plan member is responsible for. For outpatient procedures, the coinsurance is not subject to the medical deductible for Silver plans. However, you may find yourself getting billed for coinsurance when you thought the health service had just a set copayment. For example, imaging with the injection of a dye to enhance image contrast. The machine imaging scan will have a set copayment, but the injection of the dye is considered an outpatient procedure subject to coinsurance.
There are many good reasons to include qualifying adults such as parents and stepparents within a Covered California household. There can also be unintended consequences such as making the entire household eligible for Medi-Cal and ineligible for the Covered California subsidies. The best approach is to understand all of the IRS rules regarding a qualifying relative and how the inclusion of the parent or stepparent will modify the eligibility of the household for the subsidies and Medi-Cal.
Covered California is not a health plan or health insurance. Covered California is more like a farmer’s market. The market place is organized by Covered California. Insurance companies then bring their health plans to the market place for people to review. Consumers enter the market place and purchase health insurance directly from the vendors. Covered California is just creating the space for the health plan transactions.
The extraction, storage, and manipulation of your personal online data is akin to the wild west. There are few rules in this relatively young industry and what rules there are, the app gleaners ignore until they are caught violating the law. You can’t see the digital portrait you have created by your own actions on your mobile device and captured by the health insurance apps. In a sense, they own your image. Usually images you create are protected by copyright laws. In this new industry of digital surveillance and capture, you don’t own your own image.
Does my Medi-Cal insurance cover my abortion? Yes. Is my private insurer required to cover my abortion? Yes for most people. California law is clear that abortion care is basic health care, and most insurance plans must cover basic health care services. This requirement does not apply to employers that provide “self-funded” health care coverage or grandfathered plans.
Most of the links will take you to insurance agencies that can enroll you in a Covered California health plan. Unfortunately, some of the agents push indemnity and health care sharing ministry plans, not Covered California. Why do they do this? The commissions are higher for these plans. Once the consumer is enrolled in some of these plans, and subsequently want to terminate the coverage because they realize they did not enroll in real a real health plan, there is no support from the agency or the carrier.
Health insurance, at a basic level, is asset protection similar to car, life, and home insurance. Most health plans have an annual maximum out-of-pocket amount that limits your liability to outrageous health care bills in the event of an accident or sudden illness. Once the maximum out-of-pocket amount is met, the health plan covers all in-network health care expenses for the rest of the year.