Health coverage helps protect you and your family from unexpected medical expenses. When you’re covered, it’s easier to get the regular checkups, cleanings and preventive care that keep your smile healthy.
Things to Consider before selecting Health Plan that most suitable for you
What’s the difference between an HMO, PPO and EPO?
Health plans sold in California fall in these three categories. They differ when it comes to things like costs and provider networks (the doctors, hospitals, labs, and so on that your plan covers).
HMOs (health maintenance organizations) are typically cheaper than PPOs, but they tend to have smaller networks. You need to see your primary care physician before getting a referral to a specialist.
PPOs (preferred provider organizations) are usually more expensive. In exchange, you will likely get a larger network and the ability to see a provider outside that network. You can also see specialists without a referral.
EPOS (exclusive provider organizations) combine features of HMOs and PPOs. They have exclusive networks like HMOs do, which means they are usually less expensive than PPOs. But as with PPOs, you’ll be able to make your own appointments with specialists.
Is my doctor or hospital available through the plan I’m considering?
Before enrolling in a plan, it is always a good idea to confirm with providers that they accept your plan of choice.
Which free preventive services are available in the health plans ?
A comprehensive list of free preventive care available in all health plans through us can be found on the Using Your Plan page.
Copays, Deductibles and Coinsurance
Copays are a fixed out-of-pocket amount paid for covered services. Insurance providers often charge copays for services such as doctor visits or prescription drugs.
Your deductible is the amount you pay out of pocket for health care services covered under your insurance plan before your plan begins to pay for eligible expenses. The amount you pay for a health insurance deductible is determined by the type of plan you choose.
Coinsurance is your share of costs for a covered health care service after the deductible is reached. It’s calculated as a percentage.
Pre-Existing Conditions
A pre-existing condition is any illness or condition a patient has prior to obtaining insurance. In the past, people could be barred from getting a health plan because of a pre-existing condition. Thanks to the Affordable Care Act, pre-existing conditions are no longer grounds for refusing to sell someone insurance.
Essential Health Benefits
All health plans Covered California offers cover 10 essential health benefits. No matter which plan or coverage level you select, they all must offer comprehensive care. These standards make it easier to evaluate plans based on things like price and the availability of the providers you want.
What is the difference between a coinsurance plan and a copay plan?
For some services, copay plans and coinsurance plans will have different costs. With coinsurance plans, you’ll pay a percentage of a certain service; with a copay plan, these services will have set prices. This choice in plans is only available at the Gold coverage level.
Cost-Sharing Reductions
Cost-sharing reductions help you save money when you receive medical care. (Financial help, on the other hand, is the savings you get on your monthly premium.) They include savings on deductibles, coinsurance and copays, or similar charges. This type of savings is available with certain health plans.
