2016 Individual & Family Health Insurance Plans (Individuals, families and children). Health Insurance is now offered on a guaranteed-issue basis, meaning you can enroll in any companies available health insurance plan regardless of your current or previous health status.
Subsidy … Depending you your household income, when you enroll in a 2015 health insurance plan for yourself or family you may be eligible for a subsidy (discount) which may drastically decrease the monthly premium. Subsidy eligibility depends on “household income.” You can see the income chart below.
Open-Enrollment … Every year you will have access to an “Open-Enrollment” period typically from November 15, and ends February 15, which allows you to view the health insurance plans and premiums in your area and any changes which may occur for the following year. This is the time you will make any changes with your current company or enroll in a new plan/company. for the following year. Changes can only be made during the open-enrollment period unless there is a “qualifying event” which may allow you to change plans outside the annual open enrollment period. If you are looking to compare PPO plans be sure to include Anthem Blue Cross, Blue Shield of California.
4 Levels of Coverage … With all companies you will find 4 levels of coverage. The plans are categorized into four “metal levels” of coverage based on the percentage of coverage the company’s pay.
- Platinum: You pay 10% of health costs, plan covers 90%
- Gold: You pay 20% of health costs, plan covers 80%
- Silver: You pay 30% of health costs, plan covers 70%
- Bronze: You pay 40% of health costs, plan covers 60%
All plans will offer the “essential health benefits” such as: doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.
Enroll Online with the company and plan of your choice … Remember, enrollment in a health insurance company is guaranteed, regardless of one’s health history or current health status. The enrollment process is quick and easy with much less personal information then when insurance companies would medically underwrite.
Do I have to enroll during Open Enrollment? If you choose not to enroll in an “Affordable Care Act” plan in 2014, you will be fined and the penalty will be the greater of 1% of your taxable income or $95 per adult and $47.50 per child (up to $285 per family).
You can choose to buy insurance from an insurer from your state of residence. You must keep your plan for the entire year unless you start on an employer health plan or move to an area where your plan is not available. Also if your income drops to where you are eligible for Medicaid. Otherwise you must keep your plan or face the fine.
Health Care … Almost everyone gets sick or hurt, or needs some sort of medical help. To get better you usually need care, like seeing a doctor or staying in a hospital or taking prescription medications. Health Care includes many different services such as: doctors office visits, hospital stays, emergency room visits, lab and X-ray, prescription drugs, preventive care, well baby visits, well woman visits, immunizations and screenings.
Anthem in 2016 is mostly offering EPO plans, they look and feel much like a PPO, although they offer no coverage for out of network doctors. Blue Shield has a much broader PPO network in place in California. Be very careful when viewing the different health insurance company options. Make sure your doctors and hospital are “network” providers. This will save you from quite a headache.