Hi everyone this video will cover health plans available for year 2021 with a side-by-side comparison of various health plans if you are shopping for medical insurance for year 2021 this presentation will possibly help you decide what plan.
Would work best for you and your family now i want to be clear from the start that this is an educational presentation and not a sponsored video in other words no one paid me to create it and i'm not going to market or sell any particular plans here.
That being said i will highly appreciate if you like and share this video and subscribe to this channel comments are also always welcome now the information presented here applies for health plans available in california for both private and covered california health insurance plans and make sure to.
Watch this video until the end as i will provide important information regarding the changes that will happen in california and the open enrollment dates for this year now remember if you are getting your health insurance through covered california you can get additional tax credits or subsidies.
As well as enhanced plans for year 2021. by the way if you are confused about the aca law changes or have no idea what your options are feel free to reach out to me directly or comment under this video if this is a general question i am a licensed insurance agent in.
California and have contracts with all major carriers in the states so i have access to the information rates and so on and will be glad to help you can also delegate me as your agent in the covered california in case you are on your own and run into a technical or.
Other issues i'll help and there is no cost involved so let's get started now in terms of the plan design not much has changed for this year now we still have four main categories of health insurance plans bronze silver gold and platinum these categories.
Show how you and your plan share costs plan categories have nothing to do with quality of care there is also a catastrophic plan for those that qualify and usually this is for those who are that are under the age of 30. each level pays a different portion of your health care bills.
Grouping plans this way makes it easier to shop for insurance for example the top-of-the-line plan is platinum it pays the highest portion of your health care bills it also costs the most the basic plan is bronze it pays on average sixty percent of your.
Health care bills and costs the least you can check out on my website a side by side table with all these plans so as i mentioned before there is a catastrophic plan or a minimum coverage plan for those who are under the age of 30. quite frankly this plan is a bit tricky.
So if you are considering it i highly advise that you study the benefits carefully before applying for this one again this is an option only for those under the age of 30. now there is a one very important thing that many consumers do not know and end up overpaying for their health.
Insurance those who have minimum coverage plans do not qualify to receive premium assistance also known as advanced premium tax credits minimum coverage plans usually cover three doctor visits or urgent care visits with no out-of-pocket costs.
And free preventative benefits all other services will be full price but at the negotiated in network price until you reach the out-of-pocket maximum now let's talk about the bronze plans these are usually the high deductible plans on average your health plan pays.
About 60 of your medical expenses and you pay 40 percent i will go over the deductible the details for this plan shortly um silver plans are good alternative for those that can't tolerate a high deductible plan yet.
Don't want to overpay for a high level of coverage as i mentioned in the beginning of this presentation in some cases individuals may qualify for an enhanced silver plan this means that when they choose a silver plan they have based on their income.
Enhanced out-of-pocket savings through lower co-pays co-insurance and deductibles individuals in this savings categories get the benefits of a gold or platinum plan for the price of a silver plan these plans are only available on the exchanges.
Feel free to reach out and i'll help you understand if you qualify for enhanced silver plans gold plans do not have a deductible and the premium is a bit higher on average your health plan pays about eighty percent of your medical expenses and you pay twenty percent and platinum is the highest level of.
Coverage it pays on average 90 of the medical expenses and does not have a deductible and now let's take a look at a comparison of plans for year 2021. as i said this is a general plan design so no matter what health insurance carrier or plan you select.
Blue shield kaiser or oscar valley health plan health net anthem blue cross saturday health and so on you will be looking at the same plan structure if you are comparing apples to apples i have to mention this um some silver plans offered directly.
Will be slightly different so make sure to carefully look at copays coinsurance percentage and not just that how much you pay for the insurance each month because some of the plans are designed a bit weird and it might not work for all again compare.
Here are the metal categories and coverage for year 2021 before i go into the plan details i wanted to mention that in case any of the terminologies unclear please feel free to watch my videos where i explain what is a deductible what is a copay what is a coinsurance and so on this will help you navigate the benefit.
Structure of the plans and get an idea of how these plans work so let's take a closer look at this plants for the bronze plan you don't pay the deductible for the first three visits per year which includes a combination of primary care specialist and urgent care.
The lab is forty dollars copay and is not subject to deductible the annual wellness exam preventative is included at no extra cost the copay for the primary care visit and urgent care is 65 and specialist visit is 95. this might be a good plan for those that are.
Healthy and rarely go to the doctor obviously if you need more care you will have to pay more out of pocket bronze plants also can slightly differ so make sure to look at the plant benefits side by side for example the high deductible hsa bronze plan is not the same as a typical.
Bronze plan with high deductible plans you start paying your deductible from day one you start using your insurance and you might end up paying more out of pocket than if you've used um a typical bronze plan instead for the same procedures.
Again in the description of this video i will have a link to a side-by-side comparison of these plans so feel free to check it out now let's take a look at the silver plan the silver plan has a lower deductible there are no restrictions on how many times you can visit the doctor per year um you will pay deductible.
Mostly when you are hospitalized and here are the co-pays for this plan a deductible is four thousand primary care visit and urgent care is forty dollars lab tests are forty dollars as i mentioned before some of exchange plans have a slightly different plan design.
So make sure to compare these options before you buy it there is no one shoe fits all approach here so make sure you carefully look at the copays deductibles and coinsurance before you make your selection and get stuck with the plan for the entire year the gold plan.
Has no deductible the co-pays and coinsurance are lower than those for the silver plan this plan costs more each month but the insurance pays an average of 80 percent of your medical costs and you pay the rest for the gold plans there is a slightly increase in the primary care co-pay this.
Year by just five dollars and the out-of-pocket is a bit higher the platinum plan has no deductible the copays and coinsurance are lower than those for the gold plan this plan costs more each month but the insurance space and average ninety percent of your medical costs.
And you pay the rest obviously the platinum plan has the highest premium each month if you are healthy and rarely go to the doctor it might not be a good idea to buy the most expensive plan on the market right um so again the deductible primary care visit and lab tests copays are illustrated.
Here now you can take a look at a more detailed comparison on my website i can also provide a comparison of rates and plans so for example compare blue shield with kaiser oscar health net saturn sutter health and anthem blue cross vhp plans and so on there is no extra.
Fee for my services so feel free to take advantage of professional help and advice now i want to mention that dental coverage is not included in the medical plan for adults so if you need dental insurance that is separate the same applies for.
Vision only pediatric dental and vision is included in the medical plans at no extra cost since dental plans could be a bit tricky learn new options before buying it you might also benefit from the negotiated rates for dental and vision plans available.
Through covered california again i can help with that as well now as i mentioned in the beginning of this video here is the important information for california and specifically the penalty as you know the penalty was repealed in year 2019.
But other provisions of the affordable care act are still in force some states including california enacted legislation to reintroduce the penalties starting with year 2020 the legislation was approved um so on january 1st 2020 a new rule required californians to have.
Qualifying health insurance coverage throughout the year the penalty will be applied by the california franchise tax board when you file your taxes when you file your state tax return the penalty for not having insurance in california will mirror the one under the affordable care.
Act which was 695 dollars per adult and 347.50 per child under the age of 18 or 2.5 percent of your annual household income whatever is greater whichever is greater the open enrollment requirement is still enforced so in california you can buy.
Health insurance starting from november 1st 2020 through january 31st 2021 unless there will be an extension or change in the legislation these are the dates and the information at this time and the time i record this video.
Once the open enrollment closes you no longer can apply for health insurance unless you have a qualifying life event you can check out our video about the specifics of the qualifying life events so that's all for now if you have questions feel free to address it in the comments below or reach out directly to.
Us we love helping people and of course if you've found this information useful please share it and like it we will certainly appreciate it oh and one more thing if you need help with covered california please delegate me as your agent.
And i'll be able to help and throughout the years i've been a covered california certified insurance agent and i've helped many individuals with health plan selections as well as fixing issues in the covered california for mixed households that is where medical is involved fixing application issues or simply.
Helping with identity verification there is no fee for this service and i follow the protocol when helping with these cases thank you everyone and don't forget to share this video with someone that you believe might benefit from it stay healthy you