How To Guide  

 
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California Health Insurance Companies
 
Choose the Health Insurance Plan
That’s Right For You

At eCAHealthinsurance, we make choosing a health insurance plan as easy as possible.  For a detailed 33-page report explaining all your options for health insurance in California, and step-by-step instructions on how to choose a plan, simply request a free copy of our special report California Health Insurance Made Easy.

When choosing a plan, the most important thing to consider is the coverage and premium.  You should also look at the PPO network the insurance company uses.  Having access to a PPO network can mean substantial discounts in what you pay for your health care, even before you meet your deductible.  And if you have a pre-existing health condition, the underwriting practices of the insurance company should be considered.

We offer over 300 different California health insurance plans for our clients, depending on your zip code.  Companies we work with include Aetna, Assurant / Time,Anthem Blue Cross of California, Blue Shield, Health Net, Nationwide, PacifiCare, and others.  Our objective is to help you find the best coverage, with financially strong companies, at the lowest available premium.

Our Instant Quote system will show you rates for all available plans.  Once you choose a plan you like, you can apply online or print out an application and fax or mail it to us.

How to Buy Health Insurance

Like any purchase, choosing the right health insurance policy is a matter of weighing the benefits and the cost.  Most major medical health insurance plans offer coverage in the hospital, the emergency room, and at the doctor's office.  They often also have coverage for prescription drugs, and may have options for additional accident benefits.  Some companies offer maternity coverage, or life insurance riders.

Get an Instant Quote

The first step in choosing a plan is to run instant quotes.  Our instant quote engine can rapidly show you the available plans in your area, so that you can get an overall feel of what premiums will be for the different plans.  You will typically see 150 – 200 options, or more.

Your first decision is what type of coverage you want.  The quote engine shows co-pay plans and HSA plans.  Almost all plans have a PPO “network” – a list of doctors to choose from.  Most are very comprehensive – you can see the PPO network for any company you’re considering by looking at that company’s page on our website.  Having access to a PPO network can mean substantial discounts in what you pay for your health care, even before you meet your deductible.  Indemnity plans are typically only chosen by people in very rural areas.

After deciding on the type of coverage, you can use the tabs at the top of your quote results to filter your results further, allowing you to compare deductibles and co-pays.  If you then want to see more details, you can download a company brochure or see a synopsis of the plan on our website.

You may want to consider choosing a higher deductible on your HSA plan, and adding a $100 deductible accident policy.  Stand-alone accident plans that cover $5,000 or $10,000 after the $100 deductible can be viewed on our Accident Plans page.

Because these accident plans are very inexpensive, you may be able to keep your premiums lower while greatly reducing your exposure for the type of claim you're most likely to need your health insurance for - an accident.

Decide Which Type of Plan You Want

Though there are many different types of health insurance plans available, most of them can either be categorized as "Full-coverage Plans", “HSA-compatible High-Deductible Health Plans“, "Catastrophic Plans", or "Low-cost Limited Benefits Plans".

Full-Coverage Plans

"Full-coverage" plans have an annual deductible of anywhere from $500 to $5,000.  This is the part that you have to pay per year, before the major portion of the coverage will begin paying.  After the deductible, most plans will pay 80% of the next $5000 - $10,000, and then 100% up to $1,000,000 to $8,000,000.  If you are hospitalized, you are responsible for the deductible, plus the 20% coinsurance, until you meet your out-of-pocket limit.  On most of these plans you do not have to meet your deductible if you just go to the doctor, but instead you pay a co-payment (usually $25 or $35).  These plans also usually cover prescription drugs with a co-payment typically ranging between $10 and $50.  Our most popular plans of this type currently are Anthem Blue Cross Blue Shield, and Aetna.

HSA Plans

An HSA, or Health Savings Account, is a tax-favored savings account, combined with a qualifying high-deductible health insurance plan to provide lower-cost major medical protection, significant premium savings, immediate tax-savings, and a long-term investment vehicle.  HSA plans have become the most popular plans we offer due to how much money they can save most people.  For more information, please see our Health Savings Accounts page.

If you are choosing among the HSA plans, I recommend initially comparing premiums on just the 100% plans.  These plans pay 100% of covered expenses after your deductible, and will allow you to make the maximum HSA contribution with the minimum out-of-pocket exposure.  This will quickly give you a feel for which companies are most competitive in your area.  In order to look at just 100% plans, first run quotes.  Then, on the Customize Search tab at the top of the quotes results page, set "Your Coinsurance" to "<10%."

Next, decide if you want a plan that pays for outpatient charges, or if you want a more catastrophic plan that only covers charges while you are hospitalized.  You can lower your premium by choosing a plan that covers only inpatient doctor visits and prescription drug expenses.

You can quickly see if the quote you're looking at covers these expenses by clicking the Details link next to the instant quote result, and looking up Office Visits and Prescription Drugs.  The following plans cover outpatient doctor visits and prescription drugs, subject to the deductible and coinsurance:

The following plan limits outpatient prescription drug coverage to $2,000 per year and total outpatient coverage to $15,000 per year, and is less expensive than the plans above:

The following plan does NOT cover outpatient doctor visits or outpatient prescription drugs, and are usually the least expensive HSA options.

Catastrophic Plans

The catastrophic health insurance plans usually carry deductibles of $1,000 - $30,000 before paying for anything.  These plans do not cover outpatient doctor visits or prescriptions, but often offer some of the lowest premiums available.  The most popular plans of this type are Aetna's Managed Choice Open Access Value, Anthem's BC Life & Health Basic PPO, and Core Med or Max Plan, available through Assurant Health.

Check out the PPO Network

Most plans, including the HSA plans, are associated with a PPO network that offers discounted pricing.  Even if you have not met your deductible, the savings from a PPO can be significant.  You can view the doctors and hospitals in all the PPO networks.  The most popular networks in California are the Anthem Blue Cross Blue Shield network, PHCS (utilized by Assurant), Choice Plus (utilized by Pacific Care throughout the state), and Health Net's network

Check out the Insurance Company Rating

Most people will want to go with an insurance company that has a high rating with the rating organizations (A.M. Best, Standard and Poors, Moody's).  These organizations independently rate insurance companies based on their financial strength, thus giving you some assurance that your insurance company will be there when the claim needs to be paid.  As an independent broker, eCAHealthinsurance mostly deals with companies rated A- or higher, though we will let you know if substantially lower rates are available with an insurance company that has a lower rating..

Apply for Coverage

Once you decide on a plan, you can apply securely using online applications with most of the insurance companies.  If you do not see that option, you may open and print out an application, and fax or mail it to us.  All applications are submitted under the name of Wiley Long, the president of eCAHealthinsurance.  If you are working with one of our advisors, that person will be noted on your record as your assigned contact.

We highly recommend the online application process because it will greatly speed up the turnaround time.  Before beginning the online application, we recommend that you have the following information available in order to speed up the process:

  1. Your doctors’ names, addresses, and phone numbers
  2. Medications you currently take or recently took, including dosage and frequency
  3. Dates of hospitalization
  4. The name of the plan for which you are applying
  5. Your requested effective date
  6. Your credit card information to cover the initial premium

As soon as we receive your application, we will review it for completeness, and forward it to the insurance company’s underwriting department.  The underwriters then make the decision on insurability, and issue the policy.  Approval sometimes occurs in as quick as a day, while other times it can take two or three weeks or longer.  We’ll keep you informed the whole way, and let you know as soon as you’ve been approved.

Eligibility

Individual health insurance applications in eCAHealthinsurance go through underwriting as part of the approval process.  Because health insurance is designed primarily to cover you for the unexpected, a company may put a waiver on pre-existing health conditions.  If you have cancer, heart disease, or other serious health conditions you will likely be declined.  Some companies also reserve the right to rate the premium up to cover the cost of current medications.

Insurance companies also look at the application in regards to your height and weight, and may charge an extra premium if you are over their weight guidelines when you apply.  The height and weight criteria for each health insurance company is confidential to their underwriting department, and we are not allowed to post that information.  But we have put together a Build Chart that shows the maximum amount you can weigh and still be confident that you will not be rated up due to your weight with any company.  If you weigh over this amount, please contact us and we can let you know which insurance company would look at your situation most favorably, and what the likely rate-up would be.

If you have questions in regards to your eligibility for coverage due to medical conditions you have been treated for in the last ten years, please contact us with your question and I or someone from my team will contact you in regard to your best options.

Keeping the premium low

Hospital stays usually cost well over $1,000 per day, and serious illnesses or injuries can run into the tens or hundreds of thousands of dollars.  So the main purpose of health insurance is to protect your savings and assets should a major unexpected health expense occur.  Keeping this in mind, the following are methods of keeping your premiums low.

  • Managed care: Policies that allow you to go to any doctor of your choice are inevitably more expensive than managed care policies in which you choose from a list of doctors and hospitals.  Fortunately, most major PPOs are accepted at between 80-90% of medical facilities nationwide, which does not restrict your access to the providers of your choice very much at all.  In fact, having a PPO plan can save you a lot of money, even if you don’t meet your deductible.

  • Higher deductibles: The deductible is the amount you pay before the coverage kicks in.  By taking a higher deductible, you are taking on some of the risk yourself, and can often save a large amount on your premium.  Most of our clients go with a $2,000 or higher deductible, figuring they can put that amount on a credit card if an unexpected hospitalization occurs.

  • Higher copays for prescriptions and doctor visits: Again, this is a way for a healthy person who does not go to the doctor often to take on some of the risk.  Or, if you typically see a doctor no more than once or twice per year, you may want to consider a plan that does not have a co-payment for doctor visits.  This does not mean that your visits are not covered, or that they are free, it simply means that you pay the cost of the visit yourself (less any PPO discount, when using an in-network provider) and those charges go towards satisfying your deductible.

    When you consider the fact that a typical co-payment for a doctor visit is $25 or $35, compared to an average of $65 when paying for the visit yourself at an in-network provider, having a $25 co-payment may save you just $30 - $40 per visit.  If you are paying $25 per month to have this benefit on your plan, you may have to visit the doctor 8 times or more during the year just to break even, so you may be better off carrying a plan without a co-payment.

  • Compare many policies, or use an agent who represents many companies.  Shopping for health insurance is not fun, but finding the right company can make a big difference.

  • Stay healthy: Due to the way health insurance premiums are rated, premiums always increase, and usually at an accelerating rate.  Healthy individuals can change policies when that becomes advantageous, without having to worry about lack of coverage on pre-existing conditions.

  • Investigate HSA Plans: Health Savings Accounts let you combine a low-cost high-deductible health insurance policy with a savings account.  Any money you put in the account is tax-deductible, and can be used to pay medical expenses.  The low premiums combined with the tax savings results in a very low net cost for your insurance policy. 

Buyer Beware

Insurance agents seem to have a reputation just above that of used-car salespeople, and often for very good reason.  Most insurance agents are paid straight commission, and many struggle to make a living.  As a result, there is an extremely high turnover in the field, and there is high incentive for someone to say whatever it takes to make the sale.  Some of the sales tactics you may want to be suspicious of include:

  • Claims that a policy is non-cancelable.  By law, no health insurance policies can be cancelled or rated up based on claims experience of the individual.

  • An unwillingness to discuss any coverage without setting up a face-to-face appointment.

  • Policies that have set limits on room rates or surgical fees.  Though this type of coverage is better than nothing, it has the potential to leave you seriously underinsured.

  • Policies that pay for certain diseases, such as cancer.  Though these may be offered by financially solvent insurance companies, they are usually not the best way to spend your insurance dollar.

  • Online agencies that do not tell you who they are.  Our parent company has an A+ rating with the Better Business Bureau, and are proud of our longevity.

Choosing an Agent

When purchasing a health insurance plan, it is very important that you choose the right place to buy it from.

Unfortunately, most insurance agents are focused on only one thing: selling the next policy.  Here is the typical experience of the average individual shopping for health insurance.  They send in their application, and then wait.  If they call the insurance agent and ask about the status of their application, they typically get directed to call the insurance company directly.  The attitude of most agents seems to be "Hey, I sold you the policy, my job is done."

If you get coverage from eCAHealthinsurance, here are some of the benefits you’ll receive:

  • Direct and regular communication on the status of your application while it is in the approval process, so you’re never left wondering what’s going on.

  • Our personal assistance in appealing any unexpected waivers or exclusions on your policy.  We are quite good at getting risk adverse insurance companies to remove exclusions that should not be on your policy.

  • Our Annual Comprehensive Policy Review.  Each year we’ll offer to review your coverage against what else is available, and let you know if it might make sense to change plans.  This will save you thousands of dollars over the coming years.

  • Many insurance plans to choose from, so you can find the best value now, and have a choice of plans to switch to if your plan ever has a large rate increase

  • Help with claims or any other questions or problems you may have with the insurance company, anytime now or in the future

  • Access to a true expert who can answer your questions and help you choose the best plan, and answer questions you may have now or in the future (not a phone bank with 150 operators taking orders!)

When you get your coverage from eCAHealthinsurance, you get very knowledgeable and personal service from your own Personal Advisor, who you’ll be able to reach any time, now or in the future.  You’ll also get access to the lowest rates available anywhere.

We provide this high level of service to everyone who does business with us.  Sign up for coverage today, and see for yourself. If you have questions you may submit them through this website, or give us a call.  If you would like our assistance in choosing a plan and need to speak for more than just a minute or two, please call our office and tell the receptionist you would like to set up a phone appointment.  She will then take some information that will enable us to do some preliminary research before we meet.  Read more about our Consultation Services.

 

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