Types of Health Insurance available in California
Depending on the health of an individual you have a number of options when choosing California health insurance; getting coverage privately through one of the major companies (known as individual, family or senior products), being insured through your employer or having insurance through a state run program (MRMIP, Healthy Families, Medical.)
Group health insurance
If you have a California group health insurance plan then chances are your employer is helping you pay the premium or funding it fully. Having group health insurance is ideal because there is no heath underwriting. If you have a pre-existing health condition that would otherwise leave you uninsurable you will be able to get coverage through your employer.
If you own a small business you can also qualify for group health insurance. There is a number of ways to qualify depending on if you are a sole proprietor, limited liability company, corporation or partnership. Each carrier has different guidelines for obtaining coverage so it’s best to call your broker. They will instruct you as to what is required for getting coverage with the company of your choice.
Individual health insurance through private companies
As you may be aware, private health insurance applications are subject to medical underwriting. You or your family will be required to fill out a series of medical questions covering all areas of health. It’s very important to be 100% truthful on the application so your coverage is not rescinded when you need it most. Having coverage rescinded will leave you paying the full price of your medical claims.
Individual health insurance in California can be very expensive or inexpensive depending on your deductible, benefit level, available co-pays, and prescription drug coverage. In today’s insurance market, a plan with full 
coverage and a low deductible is almost unaffordable for most consumers. Insurance companies are now coming out with plans that have more reasonable premiums but include limitations on the benefits. That means they can offer office visits, prescription drugs and low deductibles at a lower premium, but assign limits to those services. For instance, you may have a limit of three office visits per year, maximum prescription out of pocket maximum of $4500, and co-pays that continue to accrue even after your out-of-pocket maximum has been satisfied. Make sure you are aware of cheaply priced plans, there are usually limitations.
The plans that don’t seem to have too many limitations are HSA compatible (high deductible) plans which most companies offer. They are good options for individuals and families that don’t go to the doctor often although they may work for individuals who do. They typically cover all services after the deductible and have good preventive care. The HSA compatible part of the plan allows you to set up a health savings account to save money for qualified medical expenses. Qualified medical expenses include dental, vision, chiropractic care, and acupuncture. When you have a qualified medical expense you just use the money you have saved in your health savings account to pay for it.
Medicare
Once you reach the age of 65 your monthly premiums decrease. This is because you have become Medicare eligible and aren’t subject the high premiums on the individual and family plans 50-65 year age bracket. The costs you will be required to pay are Medicare part B premium, your part D prescription drug premium, and your Medicare supplement premium. You do have the option of being enrolled in a plan that covers prescription drugs, medical and hospital costs all in one plan. These plans are known as Medicare Advantage plans. They have a higher out of pocket exposure then the Medicare supplements but the monthly premium is somewhat more reasonable.
Depending on what your needs may be you could enroll in the Medicare Advantage plan if you would like to have a cheaper monthly premium. You will be subject to a higher out of pock-exposure per year by enrolling in the Medicare Advantage plans. On the flip side you could enroll in a Medicare supplement and part D prescription drug plan to guarantee little to no out of pocket exposure. You will however have a higher monthly premium.
Depending on how many prescription drugs you are taking you may want to contact your broker to assist you. With there being 56 drug plans available in the state of California it may be hard to find the plan that suits you best. Your local broker should be able to tell you within a couple minutes which plan will give you the lowest out-of-pocket expense for the year. It’s a good idea to get in contact with them to help you make an informed decision with your part D and Medicare supplement/advantage plan options.
State Programs
The state programs available in California are MRMIP (Major Risk Medical Insurance Program), Healthy Family’s, and Medicaid.
MRMIP requires you to be declined by an individual carrier to be covered by the program. Once you have been declined you will need your letter of declination to submit with the MRMIP application. You need to have the application into your broker by the 18th of the month before the actual effective date desired. The only effective dates available with MRMIP are on the 1st of the month. It’s a good idea to check out the waiting list for this program. With many individuals needing coverage you may have a one, two or even 5 month wait before the coverage goes into effect. Also it’s important to remember that you must have prior coverage to waive the pre-existing exclusion. If not there’s a three month waiting period (starting on your effective date) before any benefits will be covered under MRMIP.
Healthy Families is a program for children in low wage families. It is a cheap alternative that will cover health, dental and vision insurance. You may be required to pay anywhere from $4-$15 for your child’s monthly premium per month. The highest maximum premium that a family could pay is $45 monthly. There’s also a program called AIM (Access for Infants and Mothers) which will provide low cost health insurance to pregnant women and their infants. A woman with low income can qualify. You may also qualify if you’re already enrolled in another health insurance plan and have a deductible over $500.
Medical is a state funded program that provides health insurance to individuals and families who have no income.
Contact your broker for more information on health insurance and state programs in California.
