Below are some of the most important questions to ask yourself prior to considering Covered California or any other private medical insurance plan.
- What is your income? If above $47k for an individual or $97k for a family of four you are not eligible for a subsidy through Covered California.
- Do you want to spend 10 minutes or 40 minutes completing an application? If you only want to answer medical questions do not enroll in Covered California. Covered California will have you answer citizenship, employment status, immigration status, income, as well as other personal information that is not required when applying to a medical provider on the private market.
- Would you prefer to pay more money up front in premium (monthly policy charge) or less money when you see the doctor or go to the hospital? Regardless of whether you enroll in Covered California or a private medical insurance plan, if you want lower premiums pick a high-deductible or Health Savings Account plan. If you want low copays and no deductible your costs will be considerably more upfront each month in premium.
- Do you prefer to visit a Primary Care Physician every time you need to seek medical treatment or do you prefer to go straight to a specialist? If you prefer to go to a primary care physician and keeps costs low, Kaiser is most likely the best option. If you prefer to go to 60,000 or more doctors in CA or travel across the country and want the ability to see a local doctor without high out-of-network costs you very likely would prefer to utilize a PPO network.
- Does your employer offer you medical insurance coverage or not? If you have an option to enroll in coverage through your job then you need to compare those costs against the most similar plans through private insurance or Covered California. If you are just looking for the least expensive plan it is very likely the highest deductible HMO plan will save you the most money.
- Is an additional above-the-line tax deduction of $3,250 for an individual or $6,450/year important? If so, enroll in a high deductible Health Savings Account (HSA) plan under Covered California or with a private medical carrier. In addition to paying for your medical expenses on a tax deductible basis you can pay for dental, vision, over-the-counter drugs and 100 other medically necessary items HSA Eligible Expenses.
The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act.
With healthcare premiums continuously increasing year over year, many employers are searching for options to help reduce their benefit costs.
The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.