About California Health Insurance Plans
yhealthinsurance.org has the information you need about all the different types of California health insurance plans. It can be confusing because there are many different types of health insurance coverage available. A simple explanation of these different types of health plans are below:
Individual health insurance is the most affordable and accessible choice for consumers. With individual health insurance, you can choose the plan that is right for you by choosing the benefits, deductibles, premiums and co-pays you need. Individual insurance also allows you to own the policy and can keep it as long as you pay your premium.
Major medical insurance is often a quality option for California residents who want cheap insurance for a catastrophic health issue. With most major medical coverage, the insurance company pays for emergency or catastrophic illness and treatment, not for routine or preventative care. If you want coverage only for catastrophes, and not routine visits, you can obtain major medical insurance.
If you work for a company with many employees, you can get group health insurance coverage. With group health insurance coverage, your employer may pay part of your premium and your policy will be underwritten as part of the group instead of as an individual. If you have health problems, group health insurance offers an affordable way to obtain a policy since you avoid scrutiny of your own health but instead is underwritten based on the experience of the group as a whole. Click here to Get a Rapid Quote.
What is a PPO Health Plan?
A PPO (Preferred Provider Organization) is a health insurance plan that offers some additional choice and flexibility over the HMO plan. Unlike an HMO where the member selects a primary care doctor, a PPO plan allows the member to choose to visit any doctor within the PPO plan’s network. If a member chooses to see a doctor outside the PPO plan’s network, higher co-pays are usually required by the member.
One advantage of having a PPO plan is the ability the member has to see a specialist without needing a referral from a primary care doctor like a member of an HMO plan would require. When comparing PPO plans, it is important to keep in mind the size of the network that would be available to you if you were a member of the PPO plan since costs are lower when visiting an in-network doctor. Large carriers such as Blue Cross, Blue Shield, United HealthCare, and other large carriers will have more than enough doctors available to choose from within the network. Smaller carriers may have lower monthly premiums but have few doctors contracted in the PPO’s network. 
Like most health insurance plans, most PPOs have yearly deductibles that must be met before the plan will cover major medical services. Some PPO plans will waive the deductible for routine visits and preventative care visits. Additionally, PPO plans may or may not include a prescription drug benefit. Most carriers will offer variations on the plans. For example a plan may offer the plan without any prescription drug benefit, or with only generic drug coverage, or the option of having generic and brand name drug coverage included in the plan. Of course, you get what you pay for. The more the plan covers, the more the monthly premium will be.
Another consideration for women to make when selecting a PPO plan is whether or not the plan will cover maternity costs. We receive a steady flow of phone calls to our offices from women that have no health insurance, are now pregnant, and would like to get health insurance to cover their maternity expenses.
None of the carriers will approve an application under this scenario. It is important for women that may become pregnant to have an in-force plan that covers maternity expenses. Plans that cover maternity are more expensive than those that do not cover maternity. Some PPO plans have an option to “trade-up” to a maternity plan as long as the member contacts the carrier within a period of time once they have a doctor’s confirmation that they are pregnant. This is a very good option for many women since they are not required to pay for a more expensive maternity plan until they become pregnant. hWhat is an HMO Health Plan?
A Health Maintenance Organization (HMO) is a type of health insurance plan. When selecting an HMO plan, members choose a primary care doctor. Once the member of the HMO selects his or her primary care doctor the member is required to visit the primary care doctor first for all non-emergency health issues.
The member’s primary care doctor will treat the member whenever it is within the scope of the primary doctor’s services. If the primary care doctor determines that the member needs care they cannot offer, they will then give the member a referral to a specialist. Once a referral is made, the member can see the specialist and the cost of the visit will then be covered under the HMO plan. If members were to receive medical services without a referral from their doctor, the HMO plan would not cover the expense of the medical service and the member would have to pay for the service themselves. Emergency visits are exempt from this referral limitation.
When considering purchasing an HMO plan one of the most important considerations to make is whether or not the doctor you prefer to see is available under the HMOs list of primary care doctors. If for example, you have a family doctor that you have been seeing for years and wish to continue seeing, you will want to be certain that he or she is on the HMOs list of available primary care doctors for the plan. If you do not have a regular doctor, this consideration becomes less important, although you will want to be sure that in the area you live, there are ample choices of primary care doctors available in the HMO plan.
HMOs usually require members to pay co-payment each time they visit the doctor. Co-pays in HMO plans are usually very low with the average co-pay ranging from $5 per visit to $25 per doctor visit. The HMO plan may also have a yearly deductible. A deductible may be for major medical procedure and/or for prescription drugs but is usually waived for visits to the primary care doctor. A deductible is the amount the member needs to pay before the HMO begins to pay out benefits. Some HMOs have no deductible while other plans carry a small yearly deductible.
HMOs plans can be a good choice many Americans. Millions of Americans are active members of HMO health plans.