Covered California Plans: All You Need To Know About Covered California Insurance

Covered California Plans offers health insurance to California-based residents

We always dream of living a happy life that is full of joy and no financial worries. We invest in things that can pay us back and take away our worries in life so that we can enjoy living. Health is an important part of leading a happy life. If you have health, you will feel more optimistic and confident to make decisions in life.

By health, it means that you eat well, sleep well, and get the best health treatment when needed. The best health treatment is only possible if you have the funds to afford medical checkups and prescription bills on time. This is why health insurance exists.

Health insurance ensures that you live a healthy life without any financial complications. There are many insurance companies that provide good plans so that people can afford to buy health insurance. Covered California plans are one of the best and recognized insurance plans that facilitate any individual or family.

If you are looking for insurance, you should consider Covered California plans as well.

What is insurance?

Insurance is a contract signed between an insurer and an individual based on agreed terms that are set by the insurer. The insurer is any insurance organization, public or private, that offers policies of benefits and facilities regarding a certain field. The policies in the contract are made in such a way that the individuals do not suffer from any financial loss. In other words, insurance is a way to ensure that you live without any monetary complications.

There are many insurance types like commercial auto insurance, health insurance, car insurance, home insurance, malpractice insurance, private mortgage insurance, disability insurance, dental insurance, small business insurance, and many more.

California health insurance

Health insurance is a type of insurance that covers all the necessities needed for medical care. The insurance policy is made solely for the individuals to be able to afford the cost of health treatment and get the best health benefits.

Health insurance in California is available for the residents. There are different insurance companies that offer different benefits for the residents of California. One of those insurance organizations is Covered California. Covered California plans are the best in the city.

What is Covered California?

Covered California is a California-based government insurance organization that provides health insurance to its residents for the sake of health benefits. This organization is an individual agency that is managed under the government of California.

Covered California was launched for the citizens of California under the federal Patient Protection and Affordable Care Act (ACA). Any individual, family, or small business can buy Covered California health insurance as long as they are a permanent resident in California.

Covered California plans are made by the government to fulfill the demands for the medical treatment and well-being of an individual. Covered California is one of the top health insurance organizations that people prefer to buy because of its various health benefits.

Covered California plans

Covered California has plans that are further categorized based on coverage levels. All coverage levels have these plans included that an individual or a family can choose from.

There are primarily three types of Covered California plans that are offered by the insurance organization. These plans are based on the location and company. Here are the three types of plans:

HMO plan

HMO plan, which stands for Health Maintenance Organization, is a type of Covered California plan that covers the cost of the medical bill on the condition that you need a referral from your main physician to get the insurance to pay for the medical bill of a specialist. You give a copayment of the cost with the insurance. If you go without a referral, then you have to pay the whole bill.

In other words, this plan is based on the network of doctors and medical professionals to whom you can go for the medical examination for coverage from the insurance company. Only in case of an emergency, the insurance would cover the medical bill for out-of-network hospitals.

PPO plan

PPO stands for Preferred Provider Organization. PPO plan is a type of plan that covers the cost of medical services of a doctor within the network of insurance plans without any referral physician.

You are free to choose any doctor as long as they are in the network. You have to pay based on a deductible and copayment but it is less costly compared to a non-insured medical bill. The plan covers the bill for an out-of-network hospital but it is usually at a higher cost.

EPO plan

EPO plan means an Exclusive Provider Organization plan. A person who selects an EPO plan for their insurance can only visit medical professionals that are in-network, but you do not need any referral to get checked.

Furthermore, unlike PPO, the cost of the premium is low but you do not receive any coverage if you get treated outside of the network or unless there is an emergency case.

What is Covered California Coverage?

Covered California plans are insurance plans that are divided based on coverage levels. There are four coverage levels: bronze, silver, gold, and platinum within which there are many plans that people can afford. Coverage levels are percentages that are paid by Covered California for medical treatment.

The three terms you need to know before knowing about coverage plans are medical deductibles, pharmacy deductibles, and maximum out-of-pocket. Medical deductibles are the cost you have to pay yourself for the medical bill before the insurance plan pays the cost. Pharmacy deductible is the prescription drug cost that you have to pay before insurance pays it for you. The maximum out-of-pocket limit is the limit set by the insurance plan that you have to reach. Once you reach that limit, the insurance pays the cost of the health cost for the rest of the year.

Here are four coverage levels that have Covered California plans:

Bronze coverage

Bronze coverage is the lowest coverage plan that covers 60% of the cost of a medical bill. They have cheaper premiums as well, so people who cannot afford health insurance can afford to pay this coverage easily and enjoy benefits. There are two types of bronze coverage levels that offer different benefits: standard bronze and HDHP bronze.

A standard Bronze coverage covers the benefits of treating pre-existing conditions, free preventive care and you get no deductibles on the first three non-preventive doctors’ visits. You also have the benefit of getting free dental and eye checkups for children. It offers the least subsidies among all coverage levels and plans.

This type of coverage is for people who do not need any medical services and only need coverage in case of an emergency or catastrophe. It covers the cost of all the benefits that are mentioned above for bronze coverage but with minimum deductibles which means you have to pay more out of your pocket when you go for medical checkups. It is the standard bronze coverage level offered by Covered California.

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Whereas the HDHP bronze has no limits to covered services, other services are the same as standard bronze, except the non-deductible part. Furthermore, if you open a health savings account and register it under the insurance plan, you can get more discounts for premiums. This account is separate from your personal bank account, where you can save money for medical expenses.

Most medical services require you to reach a certain deductible for insurance to pay it. Bronze has deductibles that can be costly for your pocket. Furthermore, the lower your premium is, the more you have to pay for medical services out of your pocket. There are two main bronze plans within bronze coverage:

Bronze 60 plan

Bronze 60 HDHP/HSA plan

These plans are part of bronze coverage where you have to choose between an HMO, PPO, or EPO Covered California plans.

Silver coverage

Covered California has a silver coverage that is higher than the bronze coverage. Silver coverage covers the cost of medical services of up to 70%. This coverage is beneficial for those who go to the doctor and get prescribed medicine on a regular basis. It has low deductibles, so you have to pay less for the doctor’s fee.

Silver coverage offers a moderate amount of premium and out-of-pocket expense. It is the middle of an insurance plan because you do not have to pay a very high cost for a premium. This plan is mostly preferred by people because it suits their budget more than other plans.

There are four types of plans in silver coverage plans that are offered by Covered California: Silver 70

Silver 73

Silver 87

Silver 94

These plans are updated on a yearly basis, so you have to check their official website for new plans. These types of plans are categorized based on HMO, PPO, and EPO Covered California plans.

Gold coverage

Gold coverage gives 80% coverage to the medical services with various medical benefits. You can get free preventive care checkups, there is a $0 deductible so you do not have to pay out of your pocket much compared to bronze and silver. If you have pre-existing medical conditions, they are considered by Covered California. The insurance covers the medical expenses so you do not have to worry about paying it out of your pocket.

There are set prices for the doctor visits that are covered by gold coverage, so you do not have to pay anything extra once you visit. There is no drug deductible so you can buy prescription drugs without any financial loss.

There is a type of gold coverage known as Gold 80 that covers all the medical expenses on 80% and 0 deductible. If you hate the concept of deductibles then this coverage plan is best for you.

Platinum coverage

The highest and most expensive coverage level is platinum. Platinum coverage is the lowest out-of-pocket expense for medical services because they cover 90% of your medical bill. There are no deductibles required in this coverage so you do not have to pay anything.

This coverage offers maximum benefits that any person would need in their life. They offer free preventive care, free pediatric checkup for teeth and eyes, the low copayment for other medical services, and no prescription drug deductibles as well. There are no screenings and immunization costs. Furthermore, if you have any pre-existing medical condition, the insurance covers the cost of it as well.

This coverage level is the most convenient for individuals and families because you do not have to go around paying for medical bills. Although it is the most expensive coverage level, it is worth the money you pay on a premium. You have to pick one plan, and then the coverage level you can afford to pay a premium for to enjoy insurance benefits.

Covered California dental

Although dental checkups are covered in the Covered California plans, it is only limited to children. For adults, you need to buy separate dental coverage within your insurance plan to get the benefits.

Dental checkups and treatment are really important because dental pain can cause problems in your daily life. You should buy dental coverage in the insurance plan so that you do not have to pay the costly treatment bills by yourself.

Covered California offers dental coverage for individuals and families. If you have a family, you can buy a family plan and add your kids to it too even if the insurance plan covers it for free so that if there is a complicated case, you do not suffer from any financial loss.

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There are two types of  Covered California plans for dental coverage:

DHMO dental plan

DHMO dental plan is derived from the HMO insurance plan that is offered by Covered California. You have to get a referral from the main physician to get a dental checkup within the network specified by the insurance company.

DHMO dental plan is convenient because it offers no deductibles so you do not have to pay out of your pocket for the expenses. To add more, there is no annual limit set for this dental coverage plan. There is no waiting period for children or office copays that you have to fulfill.

DPPO dental plan

DPPO dental plan is derived from the PPO plan offered by Covered California insurance. For a DPPO plan, there are deductibles for adults and kids. For each child, it is $75 and for each adult, it is $50. But there is no deductible in case of preventive or diagnostic checkups of the patient.

DPPO plan is more flexible but expensive than the DHMO plan. It all depends on the needs of the family or individual as to which plan suits you well. In the DPPO plan, you get more choices in terms of which dentist you want to visit, and sometimes you can receive coverage for the out-of-network dental bills as well.

How much does Covered California cost?

Covered California plans are based on coverage levels so they have different ranges of cost. The cost for an individual who wants to buy Covered California insurance is going to be different from a family plan.

To add more, you need to know that bronze is the cheapest insurance coverage while platinum is the highest in cost. If you prefer to buy the bronze standard coverage plan then you will have to pay more money out of your pocket for the medical expenses. It is better to choose plans that can benefit you instead of giving you nothing at all.

Each plan is made carefully to ensure that citizens of California can afford the premium and annual limits without any problems. Covered California is one of the best insurance plans because they offer benefits to all kinds of people. All coverage plans that are mentioned above have almost the same facilities with an exception of the percentage of the coverage.

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Here is the cost for Covered California plans:

Individual

If you are a single adult or looking for per individual cost of the insurance plan, Covered California offers the best insurance plans. If you buy standard bronze you will get $6,300 of the maximum deductible and $500 for pharmacy deductible. The maximum limit for out-of-pocket is $8,200.

If you buy Silver, the deductible will be from $75 to $3,700, and for pharmacy deductibles, it will be $0 to $10. You have a maximum of $800 to $8,200 out-of-pocket expenses offered by the insurance company.

The rate of deductible is $0 when you buy gold coverage and out-of-pocket is $8,200. For platinum, it is the same rate as silver for deductibles but the out-of-pocket maximum is $4,500.

Family

If you want to buy an insurance plan for your family, the cost for a family is different from an individual. For a standard Bronze coverage plan, you will get $12,600 for medical deductibles and $1000 for pharmacy deductibles. The maximum out-of-pocket you will receive is $16,500.

If you choose to buy silver, then the coverage increases by 70%, and deductibles are low. The medical and pharmacy deductibles for a family are $150 to $7,400 and $0 to $20. The maximum out-of-pocket a family gets is $1,600 to $16,400.

The deductibles for both pharmacy and medical are $0 when you buy gold and platinum coverage. The maximum out-of-pocket for gold is $16,400. And for platinum, it is $9,000. All coverage plans give almost the same facilities and benefits with the difference in coverage percentage.

What is the best Covered California plan for you?

Covered California plans are known to be the best insurance plans because they offer all the medical benefits that one needs in life. If you are suffering from any medical complications, or just need savings for the sake of managing your budget, health insurance is the best option. When you are in need of emergency medical funds, the insurance has got you covered.

Covered California is the main insurance organization set up by the government to help the citizens of California. The insurance promotes a healthy society so that people can live a better standard of living in the city. Even if you think buying health insurance is unnecessary because you are a healthy person, you will still need it to afford sudden medical bills.

There are so many Covered California plans so it becomes hard to pick the right one that suits your lifestyle and you are able to afford it. Here are some things you need to consider before you pick your best insurance plan:

Income

Your income plays an important role in buying insurance. You cannot buy expensive insurance that is more than your monthly budget because it can unbalance your savings. You need to calculate your budget carefully to know if you can afford a certain plan or not.

The cost of each insurance coverage is mentioned above, so you can compare between all the plans as to which one suits you better in terms of your income. This is especially important if you are buying for your family because you have to afford other things as well. So, the insurance plan should be affordable to you.

Medical history/condition

Covered California provides coverage for pre-existing medical conditions as well, and this is common in all coverage levels so you do not have to worry about buying the cheapest or expensive one. Other than that, you need to know your or your family’s medical condition before you buy an insurance plan to make sure it covers all the requirements for you.

If you have an old person in your family, then you will have to make the decision based on that. If you have little kids, they also need medical checkups, so you have to see the medical condition of each and every person with whom you are buying the insurance plan.

For an individual, your medical condition can help you decide whether you want accident-only benefits or a proper health insurance plan that covers all the medical procedures. It is always recommended to buy health insurance that covers all your needs instead of just basic coverage so that you live in the comfort that insurance has got you covered.

Age

Your age or your family’s age range is essential to buying the best insurance plan. Age matters because the data collected by insurance companies show that age is part of buying the insurance plan.

If you are a middle-aged person, you need frequent checkups to ensure you do not develop any disease. However, if you are in your 20s or 30s you might not need to visit the doctor frequently, so you can buy an insurance plan that is affordable and has your basic needs covered.

Profession

There are many professions like labor work that can be threatening to life or cause injuries to the individual, so they need medical attention more. Although the company pays for damages if you are injured on the site, still you need your own health insurance in case you have to pay the medical bill.

The profession is an important part of choosing the best insurance plan for yourself.

After considering all these circumstances, you will be able to pick the best insurance plan that is right for you. Sometimes the insurance plan that your acquaintance chooses might not be

Covered California application

Now that you know all the details about Covered California, you can fill out the application to apply for an insurance plan. First, you have to pick the insurance plan out of the Covered California plans. Then, you can fill out the application with all the requirements needed.

The required documents are:

– Social Security number

– Federal tax information for tax filers

– Immigration documents for non-citizens

– Employer and income information

There are two ways to fill the application:

Visit the enrollment center

You can visit the insurance enrollment center in the city physically and fill the application form. You will need physical copies of all the required documents that need to be attached to the application form.

There are many enrollment centers in California that can help you in filling out the application. For visiting the enrollment center, you need to get an appointment and then go for the application.

Apply online

If you do not have time to get an appointment and visit the enrollment center, you can apply online through the website. Applying online only takes an hour of your time, so if you are in an office, you can fill it out during your break and submit it.

First, you have to make an account on the website, then you have the option to either fill out with time, because the application gets saved, or you can fill it in one go. You need to keep the documents with you to fill out the relevant information and upload the scanned copies online.

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Apply by phone

Covered California brings convenience to its customers. You can also apply by phone through call operators. You can also call them to inquire about any information you need to know regarding the insurance plan.

You can apply by phone through the call operator. You can also call to inquire about anything that confuses you about insurance plans and procedures. You first have to fill an online form to get the enroller to call you.

You need to keep your documents close so that you are able to provide all the details needed on the spot. It takes around 30 minutes for a certified enroller to call you through an official number to help you apply for the insurance plan. They provide all the details and can help you pick out the best insurance plan that suits you.

Conclusion

You need health insurance in life to live a healthy life. People who choose not to buy any health insurance, avoid going for medical checkups when they are sick or need medical attention and manage to get better themselves to save the medical bill. This can cause problems later in life because you never know when you might develop something. Therefore, it is important that you buy health insurance for the sake of yourself.

Covered California plans are one of the best insurance plans. You get so many medical benefits and facilities that lead a stress-free life knowing that you can afford any kind of medical treatment once you have an insurance plan. The way to happiness is health, and health insurance gives it to you. So, apply for health insurance today!

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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