Getting Started - 3 Easy Sections



Section 1 - Tax Credit

The tax credit affects everything now.  Based on income and size of household, we can get monthly help to bring down the cost of your chosen plan...Significantly!  We have to enroll through Covered Ca for this option.
Look to see if you might fall in the income ranges below...we can help with this process!

HOUSEHOLD - Everyone who files together on a 1040 tax form for this calendar year (next year's tax filing).  Whether enrolling or not, we include all members.  This affects the tax credit for those enrolling.

WHAT INCOME -This can be tricky...we're here to help and our assistance is free to you.  We're estimating line 37 on the 1040 tax form for this year (next April).  Self-employed people will use net business income.  We can adjust income estimate during the year.
 
You can find more detail on how to calculation income here.  

ENHANCED SILVER PLANS - Your income estimate can also affect your benefits!  In certain ranges, you'll get much richer versions of the Silver plan for the same rate.  
 

? - How To Use This Information

Now's the time to run your Quote (will open separate window)
 - Run "On Exchange" quote always
 - Make sure to put in your household size and income info

If you're offered the Silver 87 or 94 benefits, it's really hard to argue against these plans.  They are SOO much richer in benefits for the same price of the normal silver.  There's no reason to go richer.  If you just want the lowest priced plan on the market, go to next question.  
 
For Silver 87 or 94 plan selection, skip down to Section 3 on Doctors and Networks!
No worries.  Keep answering below!
Not sure?  Check with us. This is a big big deal and we can help you figure out if you get this option.

If you want the lowest priced, catastrophic plan, look at the Bronze level plan (either Bronze 60 or Bronze HDHP - the HSA version).  People under 30 have access to a catastrophic plan but it's slightly cheaper than the Bronze and we can't get a tax credit.  Bronze is better for Catastrophic.
 
For Bronze plan selection, skip down to Section 3 on Doctors and Networks!
Okay!  We need some richer coverage.  We'll get into that in section 2!  Think Silver and above.
No problem.  In section 2 we'll see if the extra premium you would pay to go richer in benefits is justified by the benefit difference.  Worse case, check with us!

TIP!  Money funded in the HSA may bring down your line 37 which could mean more tax credit!  More detail on HSA's HERE
 
For HSA plan selection (will say HDHP in plan name in quote), skip down to Section 3 on Doctors and Networks!
Check!  No HSA's.  That usually means we want some first dollar coverage for office visits, rx, etc and we don't want to put away extra money to fund the HSA account.
HS what???   We understand.  This term is new to many people.  It can be a great tool and we're happy to walk through it with you!


So...if you're offered the Enhanced Silver benefits (especially $650 or $75 deductible) OR if you just want catastrophic, lowest priced plan OR if you want HSA qualified.  We have our answer! 
 
Let's look at the plan levels for everyone else!

Section 2 - Plan Level Selection

Let's Look at the 4 Plan Levels Now.  We can now choose between Bronze (two types...Bronze 60 or HSA), Silver, Gold, or Platinum.  
 
A Cheat Sheet of the Benefits HERE.
Link to the rates for these plans if you haven't already quoted HERE.
You can access the online application anytime HERE.
 
Let's get started!

SOME KEY TIPS BEFORE STARTING - Let's rule out some big concerns (preventative, treatment of catastrophic coverage - Max out of pocket, and treatment of smaller bills - copays)
So far...so Good!!

PLAN OVERVIEW - A simplified view of the 4 main plan levels.  Focus on the deductible, copays, and max.  That's where the rubber meets the road in health insurance!  More detail available through quote HERE.

HOW TO COMPARE THE PLANS - It's all about annual premium difference from level to level versus YOUR expected (or worse case) exposure.  You'll see it's about $2K difference in exposure (little more from Bronze to Silver) at each level.  What's your premium difference?   Compare those two numbers!
one more insider tip!

AGE HAS A BIG IMPACT - As we get older, the annual savings between levels goes way up!  This means a person in their 50's, 60's, and maybe even 40's should stay with Bronze or Silver (probably).  We can help with comparison when you run Quote HERE.

? - How To Use This Information

Now's the time to run your Quote (will open separate window)
 - Run "On Exchange" quote always
 - Make sure to put in your household size and income info

Copays for office visit, RX, lab, and x-ray start at the Silver level.  If you have expected costs there, the Silver is probably the way to go.  If your savings from Silver to Gold plan is above $1800-2500/year, Silver definitely makes sense.  
 
For Silver plan selection, skip down to Section 3 on Doctors and Networks!
Super healthy!  Got it.  Look at Bronze.  Maybe Silver.  Probably doesn't make sense to go much higher unless you're really young.
Basically, do want more help for day to day expenses (office visits, rx, lab, x-ray) and bigger bills from say..$2500 to $6K?  Silver might make more sense if so.  You're going to pay most of your expense with the Bronze level.  Section 2 will help.

It might make sense to look at Gold and Platinum level.  Might!  If your not saving much in annual premium from Silver to Gold, it MIGHT make sense to go richer.
 
For Gold or Platinum plan selection, skip down to Section 3 on Doctors and Networks!
The annual premium difference really jumps as we get older.  Meaning...if we pay $2K in extra premium per year to know our deductible down by $2500, that's not a good trade off.  
 
Also, if you're expecting bigger bills, you may want to go richer as long as you don't pay too much in premium for the extra benefit.  We can help compare!
Compare your premium difference per year versus $2K.  That's usually a good guestimate of benefit difference from level to level.  We can help!


Look...health insurance is complicated.  If you don't fit neatly into a box (who does), call us at 800-320-6269 or email us for help.  Our assistance as Certified Covered California is 100% free to you!  
 
Let's look at Doctor Networks...it's a big deal now!

Section 3 (finally) - Doctor Networks!

The "New" Doctor Networks.  The networks for individual/family have changed a lot since 2014!  It's the biggest issue we generally face since they're smaller.  
 
A provider search is available under each plan when you run your quote HERE.
You can access the online application anytime HERE.
 
Let's get started!

BEFORE WE START WITH DOCTORS - Some inside tips!
 
 
What really matters?  The networks are smaller now. Email us your doctors and cities...we'll check on them for you!

A LOOK AT THE THREE MAIN NETWORKS - HMO's, PPO's, and EPO's...what's the difference?
More detail here:
HMO versus PPO
PPO versus EPO

 The benefits are standardized now (+/- 2%) so choice of doctor becomes very important.  But only second to cost!  You may find a regional HMO Silver plan that's cheaper than a PPO Bronze plan.  You have to consider that.  We can help compare these!

? - How To Use This Information

When you run your Quote (will open separate window), a Doctor Search link will be under each plan
 - Run "On Exchange" quote always
 - Make sure to put in your household size and income info
PPO first, then EPO is where you want to start.  If your doctor takes a specific plan, that may be the deciding factor.
 
For PPO/EPO plan selection, run your Quote below!
Consider HMO's...especially regional HMO's if available, some of which have great pricing and good doctor networks.
The HMO versus PPO/EPO question is really a comparison of cost versus doctor options and health care control.  People usually have a good sense of their preference but it may come down to affordability.  You have to be able to afford the plan!

PPO and EPO with either Anthem Blue Cross or Blue Shield of California will give you access to the Blue Card network which has BCBS providers in other States.  
 
For Anthem Blue Cross and Blue Shield of California PPO/EPO plan selection, run your Quote below!
HMO's are based on your area and generally require you to remain in that area other than a true emergency.  This flexibility may be bring your cost down!
In a true emergency, you'll be fine out of your area.  If you have good providers in your local HMO (usually more populous areas), that might work.  Look at the cost difference...that may answer the question right there!

Look at regional HMO's if available (Molina, Western Health Advantage, SHARP, LA Care, etc).  
 
For Regional HMO's plan selection, run your Quote below!
PPO's and EPO's will give you more control and a larger selection of doctors.  
Your area and current doctors will answer most of this question.  Check the directory through your quote and/or ask you doctor what "Covered California" plan do they participate with.

PlanFinder Wrap Up!

What to Do?
 
Run your quote HERE if you haven't already - This is the place to start.  Compare the plans.  Make sure to enter your household size and income estimate for the tax credit.
 
Get Help - Our assistance is 100% free to you.  We are Certified Covered California agents.  We have enrolled 1000's of Californians in Covered Ca and off-exchange.  Call 800-320-6269 or email us.
 
Enroll Online - You can access the simplified application for Covered California HERE.  
 
You will generally receive an enrollment confirmation by email within 24 hours during business days followed by mailed confirmation from Covered Ca 5 days later.
 
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