Individual Plans
Health Insurance Redding Ca
Having good health insurance is very important. An unexpected trip to the hospital can be financially devastating to most people. With all the overwhelming choices available today, it is even more important to make sure you have the right plan. Call Ross Rogers Insurance Services today to discuss the best plans and prices in your area. Our help is always FREE!
Individual Health Plans
In the Individual Insurance Market, there are two places to get health insurance. People can enroll through CoveredCA or buy plans directly from the insurance companies. The plans and networks of doctors are the same, either way. If you can qualify for a subsidy (based on house hold size and income) you can get help paying for your plan if you purchase it through CoveredCa, thus saving you money!
Open enrollment for Individual and Family plans is scheduled to start November 1st, 2015 through January 31th, 2016. To enroll, please call (530) 255-8086. We offer FREE advice and can handle most of the enrollment process for you. Also, we offer needed support behind the scenes to make sure your enrollment goes as smooth as possible, whether you’re enrolling through CoveredCA or directly with the Insurance Company. All at no cost to you!
Overview
The passing of the Affordable Care Act brought on many big changes for individual health benefits. Historically, an individual’s health insurance rate or premium was based on a medical underwriting process of that individual’s health. This approach was suitable for healthy individuals, but often left those with existing health problems paying a lot more for their insurance coverage, or not being approved for coverage at all.
All this changes January 1st, 2014 when ALL individual health insurance plans become guarantee issue. This is good news! Guarantee issue means that an individual’s health is no longer a factor in their insurance premiums, and that an individual with a “pre-existing condition” or a lot of medical needs will not be charged any more than a healthy person.
Plan Subsidies
Another major change starting January 2014 is the introduction of premium subsidies, also known as the “Advanced Premium Tax Credit”. These subsidies are based on family income and will be paid directly to the private health insurance plan that is chosen. Use the Calculator to estimate your subsidy now! It is important to note that premium subsidies are only available to insurance plans purchased through the new Public Insurance Marketplace, also known as the “Insurance Exchange” If someone does not qualify for a subsidy, they can find many affordable options outside of the Exchange. And we can help with that too!
Frequently Asked Questions:
What is CoveredCA?
CoveredCA is California’s state run insurance exchange. It mission is to provide “Californians with access to affordable, high-quality health care”. Subsidies may be provided for plans purchased through CoveredCA, making your health insurance more affordable.
What is a subsidy?
A “subsidy” is money paid by the government directly to your health insurance company on your behalf. These subsidies lower the amount of the insurance YOU have to pay. The amount of subsidy you will receive is based on your household size and income. These subsidies are only available if you purchased your plan through CoveredCA. It is important to note that if your employer is offering you affordable coverage, you are not eligible for a subsidy through CoveredCa.
Can I be turned down for insurance because of my health?
No, you cannot be turned down for insurance for an pre-existing condition or health needs. All insurance is “guarantee issue” meaning there are no health questions. However, you can only buy health insurance once a year during open-enrollment (for 2015 open enrollment is from November 1st, 2015 to Jan 31st, 2016) OR within 60 days of a “qualifying event”. A qualifying event is a loss of coverage, marriage/divorce, moving to the state or out of one of your states insurance regions, birth of a child, etc. Please click here for a full list of “qualifying events”.
Why should I use Ross Rogers Insurance Services?
Shopping for insurance is overwhelming. There are many options available, and picking the wrong plan could be financially devastating. Ross Rogers Insurance Services offers FREE advice and can handle most of the enrollment process for you. Also, we offer needed support behind the scenes to make sure your enrollment goes as smooth as possible. All at no cost to you! The better question is “why would you not use Ross Rogers Insurance Services?”
Is preventative care covered?
One of the requirements of the Affordable Care Act (ACA) was for plans to provide 100% coverage for “preventative care”. Preventative care includes once a year physical exam performed at a doctor’s office. Because it is covered 100% by the insurance company, there should be no cost for you for the exam (using in-network providers). There are different services covered depending upon a person’s gender and age including but not limited to: Mammograms, Pap smear, colonoscopy, PSA testing, lab work, etc. FYI, if the doctor finds something during the preventive exam that requires further treatment/diagnosis, there may be a separate charge for those procedures outside of the physical exam itself.
What is pediatric dental?
Pediatric dental is dental insurance for children up to age 19. In most cases, this coverage is built into the medical insurance, however, if it is not built into the medical, it will need to be added. Pediatric dental is a required benefit on all ACA health plans. There are different plans and networks for pediatric dental depending upon what insurance carrier you choose. There also may be a separate charge for this benefit.
Can I get a subsidy if I bought a plan outside of CoveredCA?
No, you can only get a subsidy if you purchased your plan through CoveredCA.
Are the plans on CoveredCA different from the plans offered directly from the insurance company?
For the most part, No. The plans offered on CoveredCA are the same plans offered directly from the insurance companies. They even have the same network of doctors that accept them. However, depending on a family’s size and income, some people may qualify for a better plan with a lower or $0 deductible that is not offered elsewhere. These are called “cost sharing reductions”. Please contact Ross Rogers Insurance Services for more information and to see if you qualify.
Can my family pick different plans on CoveredCA?
No. For Families that file their taxes “married filing jointly,” all family members need to be enrolled on the same plan. The only exception to this would be if children qualified for Medical (Partnership Health Plan in Shasta county) or if one member was a documented American Indian or Alaskan Native.
If I do not qualify for CoveredCA, can I still buy a plan?
Yes, the only purpose for CoveredCA is to buy a plan that qualifies for a subsidy. If your income is too high or too low to qualify for CoveredCA, you can still purchase a “non-subsidized” plan directly from many different insurance companies. You can enroll during open enrollment (Nov 1st, 2015 through Jan 31st, 2016) OR within 60 days of a “qualifying event”. A qualifying event is a loss of coverage, marriage/divorce, moving to the state or out of one of your states insurance regions, birth of a child, etc. Please click here for a full list of “qualifying events”.
What if I choose not to buy insurance?
Health Care Reform required that all Americans need to have health insurance. If you do not have insurance, you may be charged a penalty for not having coverage (see below).
The Importance of knowing your network
Having good health insurance is very important. An unexpected trip to the hospital can be financially devastating to most people. With all the overwhelming choices available today, it is even more important to make sure you have the right plan. This includes know what type of insurance networks are available in your area, and what network will work best for your specific needs. There are different types of insurance networks with different types of insurance plans.
PPO
A PPO plan (Preferred Provider Organization) is a health plan that is considered “freedom of choice”, meaning you can go to any doctor that accepts that health insurance plan. In most cases, you do not need a referral form your primary care physician. The insurance company has already negotiated the prices for procedures with in-network doctors. When you go to an in-network doctor, all services will be paid/applied to the in-network benefit of your plan. Because of this, the doctor must take this amount as payment in full, and is not allowed to “balance bill.”
However, many PPO plans also have an “out-of-network” benefit, meaning that if you go to a doctor that isn’t inside the PPO network, you can still have some of the expense apply towards your out-of-network benefit. It is important to note that going out-of-network could result in you being “balance billed” by your provider. When you go out of your insurance company’s network, most insurance companies will only pay a portion of what they would have paid an “in-network” doctor. This could result in the out of network provider “balance billing” you for the rest of the costs not covered by your insurance. Again, in-network doctors are not allowed to balance bill.
HMO
Another type of health insurance plan is called an HMO (Health Maintenance Organization) and is more common in larger, metropolitan areas. HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO plan, you will need to pick a primary care physician (PCP). Your PCP will typically take care of most of your health care needs. If you want to see a specialists, you will need to obtain a referral from your PCP. Unlike PPO plans, HMO’s have little to no out-of-network benefit. Therefore, if you choose to go to a doctor or facility that in not part of your HMO, it may not be covered by your insurance.
EPO
Another type of health insurance option is called an EPO (Exclusive Provider Origination). Many of these plans, like an HMO, do not have any out-of-network benefit. It is very important when purchasing an EPO plan to verify that the providers (Hospitals, Doctors, Specialists, etc.) that are important to you are contracted as “in-network” by your insurance companies EPO network. There are a few ways to do this. One, you can do a provider search of the health insurance companies EPO network on their website, or you can contact Ross Rogers Insurance Services and we can look this up for you. Call today!
We Provide:
- Health Insurance Plans with Covered CA
- Health Insurance Plans direct from Insurance Companies (Anthem, Blue Shield, etc.)
- Health Care Reform Consulting and Support
- Insurance Subsidy Calculations
- Life Insurance
- Medicare Supplement Plans
Remember, you may be charged a penalty if you and your children do not have health insurance coverage. Schedule your appointment and let us help you understand your options and choose the plan that is right for you!
Penalties for Not Being Insured
- In 2014, the annual penalty will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater.
- In 2015, the penalty will be $325 per adult and $162.50 per child, up to a family maximum of $975 or 2 percent of family income, whichever is greater.
- In 2016, the penalty will be $695 per adult and $347.50 per child, up to a family maximum of $2,085 or 2.5 percent of family income, whichever is greater.
Most people think of the penalty as annual expense, however it is imposed on monthly basis. These penalties will be due to the government at the end of the year when you pay your taxes. You will pay a penalty for any month that you are not covered. However, a person may be without coverage for up to three months without triggering the penalty.
Give Ross Rogers Insurance Services a call today @ (530) 255-8086 to find out more about obtaining a life insurance policy that meets your needs.
