It is common knowledge that an individual without health insurance, in need of medica treatment is either not taken care of completely or has to pay a large sum to get access to medical aid. If neglected, there could be serious repercussions on one’s health and finances. Not just that, good health contributes to the natural flow of things in an individual’s routine and if obstructed, it could even lead to loss of professional, mental and physical balance. If one wants to live a stress-free life without the interference of medical issues, one must definitely look into investing in health insurance long term.

Health insurance is a financial backup to pay for expenses incurred from medical services and is an important decision to make in one’s life as the right insurance will cover all your expenses and not leave you penniless. As essential as health insurance is, it can also be expensive if you don’t pick the right policy for yourself. Let’s say you’re a resident of Anaheim, you must know that health insurance in Anaheim is a legal requirement as stated by the Californian law. If any person does not have health insurance in Anaheim, they can be penalised for the same.

The key features of a health insurance policy are listed below;

Premium

A premium is an amount fixed by you or your employer (if you are on a health plan picked by your boss) with the insurance company for a time period set mutually to have accessible healthcare. The sum you pay towards premium for your insurance policy also determines how much you pay out of your pocket.

Out-of-pocket amount

The payment made by any insurance policyholder towards coinsurance, copays and deductibles is called out of pocket amount. The maximum out-of-pocket expense for a policyholder corresponds to the maximum amount he/she pays for health insurance services per year. The cap on the amount of out-of-pocket ensures a limit on the cost borne by a policyholder.

Deductible

The sum you pay for healthcare out-of-pocket before your insurance kicks in is called deductible. It so happens that insurance policies with lower premiums tend to have higher deductibles and often, even though a policy holder has paid the deductible, they have to pay for the copays and coinsurance till they have topped out their out-of-pocket amount. Now the different between out-of-pocket and deductible is that out-of-pocket is the total amount you pay for towards medical care including your deductible whereas deductible is some of the amount you pay till your insurance starts paying. For example, lets assume you need medical care costing $3000 and your deductible is $1000, your insurance company won’t pay anything till you’ve met your deductible amount of $1000.

Copayment

A copayment, also known as “copay,” is a fixed amount one pays for in addition to their premium for a certain service or prescription medication. Meaning, some health insurance plans have copayments for a visit to a doctor, prescription drugs, etc before one meets their deductible amount whereas some insurance companies split the amount with you after you’ve met your deductible.

Coinsurance

Another way insurance companies split costs with a health insurance policy holder is coinsurance. Coinsurance is a percentage of the cost one pays, for covered services. For example, if you’ve met your deductible and your health insurance plan’s allowed amount for an office visit is $200; your coinsurance amount of 20% would be $40. Your health insurance plan would pay the remaining 80%, or $1600. Some plans also allow you to split it as 70/30 or 90/10.

The benefits of having health insurance are many but the ones that all insurance policies must provide are as follows;

• Ambulatory patient services (outpatient care one receives without being admitted to a hospital)
• Emergency services
• Hospitalization for surgery, overnight stays, and other conditions
• Pregnancy, maternity, and new-born care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices (treatment and devices that help people gain or recover mental and physical skills after an injury, disability, or onset of a chronic condition)
• Laboratory services
• Preventive and wellness services, as well as chronic disease management
• Paediatric services, including dental and vision coverage for children

The conclusion is that one should not even consider not having a health insurance policy because medical services are not cheap and to have access to even basic services is essential to leading a stress-free life.

Here is everything that you need to know about this insurance mechanism, how to get it on the personal level, how to go for family health care insurance and more : –

• The duration of enrollment for health insurance varies from state to state but the total duration is fixed and is usually for six weeks. Only in special cases, you will be allowed to take health insurance after the prescribed period.
• Going for health insurance is not mandatory and a non-compliance will not invite a penalty in every state. In 2020, these states have the individual mandate on health insurance- California, District of Columbia. Massachusetts, New Jersey, Rhode Island, and Vermont. Not just for 2020, whenever you are planning to go for health insurance in the future, it is important to check the mandate and find out if something is mandatory or not.
• This open enrollment time is not just meant for new insurance policies but is even the time when you can make changes in your existing health insurance plan and adjust the coverage or the amount of annual premium that you are supposed to pay. Besides this, you can even use this time to renew your existing policy before it expires.
• It is important to understand that this enrollment window is only open for health insurance. This includes individual health insurance, family health care insurance and other types of health insurance. You cannot buy any other type of insurance policy under this scheme.
• Missing out this enrollment period might mean that you will have to wait for 1 year to get your health insurance. However, in special cases like divorce, marriage, the birth of a child, adoption, death of the partner that leaves you without an insurance coverage, the partner whose insurance policy covers you loses the job and health insurance, you fall out of the eligibility of employer’s health insurance plan and more, you can get a health insurance even outside the enrollment duration.
• For both individual and family insurance plans, you have four options for the type of policy that you can choose. These options are Bronze, Silver, Gold, and Platinum.
• As per ACA, 2020, there has been a considerable reduction in the value of insurance premiums when it comes to health insurance. Some costs have dropped for the first time while other premiums are close to 1% making it beneficial for everyone. Even if it is not mandatory in your place to go for a health insurance policy, you should consider it as a wise investment and make this investment for your health and cover the contingencies of the future. Not every year the premiums would be as low as they are this year. It is also important to understand that not every premium has dropped. So, make sure that you read the terms and conditions and do some research before going for a health insurance policy.
• Every health insurance plan must cover some mandatory benefits. These include the care of the patient including chronic diseases, emergency care, expenses of hospitalization, pregnancy care, newborn care, mental health care, prescription medicines, rehabilitation expenses, cost of testing, preventive measures and dental and eye care expenses of children. The percentage of coverage varies from policy to policy.
• Your eligibility for tax credits depends on the number of your family members, your income and the family income.
• You have multiple short-term and long-term options when it comes to going for health insurance plans. Usually, the short-term plans offer low-cost alternatives that can easily fit into everyone’s budget. So, if you are planning to leave the state or want to change your health insurance plan in the near future, it is better that you go for a short-term plan to save money while paying the insurance premiums and yet enjoy the coverage of a regular health insurance plan.

Health insurance exchange in California has also become more comfortable than before. The Affordable care Act has ensured that you have consumer protection in your corner. You can buy individual health insurance only during the open enrolment program unless the circumstances are exceptional. The era before 2014 saw you purchase individual health insurance at any time of the year. The insurance Act declares that you are mandated to enroll in a health plan. If your current policy does not meet the minimum services in your current project, you will need to change your plan.

Why do you need individual health insurance?

The Covered California Exchange is meant for legal citizens of America. It would help if you bought health insurance that meets the requirement of the legal mandate set by the state. If you do not avail of the same, you might face a stiff penalty.

Individual health insurance is also needed in California in the following circumstances:

• Your employer is not inclined towards adequate group plans.
• You are self-employed and need to buy medical insurance for yourself and your family.
• The group insurance plan that covers you at work but does not help your family.
• Your benefits needs have changed drastically, and you need to buy a new medical insurance plan.
• Your premiums are not affordable, so you might need to downsize the investment in a health insurance plan.

What types of individual and family health insurance plan is available in the market?

The structure of individual health plans is varied. The method determines how much you will end up paying for your medical insurance premium. The ACA mandates that all medical insurance plans must follow simple guidelines. The minimum coverage that is essential under any scheme ensures that all citizens of America cannot be denied within the open enrolment period.

Comparing health insurance plans in California is very easy today. The five major types of plans are divided according to the out of pocket expenses that you are required to make when you need medical treatment. The different healthcare benefit categories are as follows:

• The Platinum plan pays 90% of medical care needs. Your extra expenses are only 10%.
• The Gold Plan is the next category. This plan pays 80% of the bill, and you have to cough up the remaining 20%.
• The Silver plan follows the gold plan. The medical costs are insured for up to 70%, and you have to pay 30% of the total cost.
• The bronze plan pays you 60% of the total cost through your health insurance, and you have to arrange the rest 40% of the medical bills.
• The last category is aptly called the catastrophic plan. These are suitable for individual people under the age of 30 years or who are experiencing extreme financial hardship. The plan pays for less than 50% of the total medical costs incurred by you.

You can choose any of these plans, but you must match it to your current requirements. The Platinum plan is best for you if you need regular medical care. In contrast, the catastrophic plan is the one that only the young ones go for as they generally have no medical issues, or have to be taken by people who cannot afford it.

It will help if you match your needs with the plans available. The questions that you need to ask yourself are as such:

• What the plan covers in totality?
• Which healthcare providers in the network?
• How is the plan structured?
• How much of your medical cost does your plan pay?
• What is the out of the pocket expenses for medical treatment?

It is essential to match your budget to your health insurance. It is crucial that you think not only from the cost angle but also from your specific medical needs. Covered California has made it easier to compare the various plans. Make a smart plan that covers all the contingencies.