Many Americans will qualify for a federal subsidy to pay part of their health insurance premium, which depends on their Modified Adjusted Gross Income (MAGI) . Individuals and families earning up to 400% of the Federal Poverty Level will be eligible to qualify for a federal subsidy. The Federal Subsidy depends on your family size and modified adjusted gross income, to calculate please use the federal subsidy calculator.

 

 

If your Modified Adjusted Gross Income (MAGI) is in between 139% and 250% of the Federal Poverty Level(FPL) are offering next to the subsidy also a cost sharing towards copayments, coinsurance and out of pocket maximum.

In 2016 there will be wider choices of medical networks, and therefore check if your particular doctor or hospital is in the network of your insurance choice. In general to lower the cost the Affordable Care Act health plans (ACA plans) insurance companies offer smaller networks. Therefore it is critical to research if your preferred doctor and hospital is in the network of the exchange health plans. The good news for 2016 is, that Anthem is going back to a true PPO (Preferred Provider Organization) in the Southern California area meaning you can choose doctors outside the network. A new Health Insurance Carrier named Oscar , will be offering intuitive technology tools with a health risk assessment online guide and a preventative care checklist. Blue Shield remains a PPO plan and is now contracted with UCLA and Cedar Sinai and has the Providence Health & Services as their preferred hospital.

In California the only rating factors for premiums are based on geography, age and family size.

 

 

a) Geography : There are 19 regions in California, each rating area will have their own cost of care applied

b) Age: Rates based on age will differ by no more than a 3:1 ratio. In the past this ration was 5:1 or higher. The 3:1 ratio says that the cost of the highest age may be no more than three times the cost of a young adult. We expect that the rates for young adults will increase.

c) Family Size
In determining a family’s total cost, all adults (subscriber, spouse, adult children) age 21 and above are rated separately under family coverage, and only the three oldest children who are under age 21 will be rated in the total family premium.

Rate guarantee:
Rates for a health plans are guaranteed for a full calendar year, or the duration of the calendar year for special enrollment. Rate adjustments due to age changes can only occur during open enrollment or special enrollment periods

Double check with your insurance if your doctor is an In Network Provider. Using out-of-network doctor can be very costly, as the insurance companies with a PPO plan are only paying their standard rate and you are responsible to pay the doctor the remainder. With the introductions of EPO’s ( Exclusive Provider Organization) covered benefits are not paid for services rendered by a provider who is not part of the provider network except in emergency or plan approved care outside the provider network.

Bronze Plans plan are less costly than the other metal plan of the ACA plans. If you have a Bronze plan you need to meet the annual medical deductible of $ 6300 before Emergency Visits, Xray, Diagnostics, Hospital and OutPatient Medical Treatment will be covered. The drug deductible will be $ 500. After the drug deductible is reached you pay $15 for generics $ 50 for preferred Drugs $ 75 for nonpreferred drugs or 20% coinsurance for Specialty Drugs. The Out Of Pocket Maximum is $ 6800. On the Silver Plans the drug deductible is $ 250 for brand prescriptions. Gold and Platinum plans will not have a drug or medical deductible.

In order to offset the steep increases in health insurance premium, many families increase the deductible on their health plans. If you do this, start putting each month $ 100 towards a saving account, so that you are able to pay your bills when the unexpected happens. With the new metal plans evaluate if a Bronze plan is really suitable for your needs. Bronze plans have a deductible of $ 6300 for medical and $ 500 drug coverage, the out of pocket maximum is $ 6800 for an individual and $ 13600 for a family. You have only limited doctor visits before the deductible applies. Please compare the Silver Plans to the Bronze Plans although the Silver Plans are more expensive they offer over all a better benefit package

To be prepared for the unexpected add a supplemental insurance. Add a critical illness insurance, which will pay you a lump sum, if you have a critical illness. Young families can add an accident insurance, for as little as $40, – per month, or singles for $20, – a month.

After the deductible is reached, you have to pay a coinsurance, which can be as little as 10% Platinum Plans or as high as 40 % Bronze Plans until you reach the Out-Of-Pocket Maximum.

 In-Side the Networks of an Insurance Carrier’s Health Plan , Platinum Plans have a maximum out-of-pocket limit for an individual of $ 4000, for a family of $ 8000. Gold and Silver Plans have maximum outpocket limit of $6750 Gold and $6800 Silver for an individual and for a family of $12500. Bronze Plans have a maximum outpocket of $ 6800 for an individual and $ 13000 for family .

Out-Side the Networks of an Insurance Carrier’s Health Plan the out-of pocket maximum can be considerable higher.

In order to do our job properly we keep up to date with the newest insurance plans and newest health care reform changes. We know which plans have loopholes and research the networks of each health plan. We will determine if you qualify for subsidies. We will guide you through the application process. Filling out an insurance application can be very difficult. A meeting or telephone conversation with us, will help you to successful guide your through the application process.