By Michele Campbell , Independent Agent
Michele has been in the insurance business for over 25 years and specializes in the Medicare , individual health and life insurance . She is passionate about helping her clients to find the right plan to fit their needs . She is an active member of the Gilroy Chamber of Commerce , Gilroy Rotary and Gilroy Leadership Class of 2015 . Visit mcinsuranceservices . com or call 408.848.2271 .
MEDICARE INSURANCE
Medicare annual open enrollment period closed December 7th , however , if you ’ re not happy with the Medicare Advantage plan you chose , Medicare offers a “ Dis-enrollment Period ” where you can dis-enroll from an Advantage plan . You have to do this between Jan 1st and Feb 14th and then your insurance converts back to original Medicare , Parts A & B , and this allows you to add a drug plan and if you qualify , pick up a Medicare Supplement plan . ( to supplement your Medicare A & B ) During this Dis-enrollment period , you cannot switch to another Medicare Advantage plan , you can only do what is just mentioned above .
INDIVIDUAL HEALTH INSURANCE Open enrollment is in full swing for the individual market now . You have until January 31st to make your final change , even if you ’ ve already made a plan change . Very few counties have added new carriers . For most people , their options haven ’ t changed much . It ’ s really all about what plans your doctor accepts first , then choosing the best plan for your needs . If you choose the reverse way , you could choose a plan your doctor doesn ’ t accept , which will leave you very disappointed when you show up at your doctor ’ s office , to be told they don ’ t accept your plan . Beware that your doctor can also choose to stop accepting a plan mid-year . There is nothing you can do about that , nor make a plan change mid-year to follow your doctor .
ON EXCHANGE : Covered California ( California ’ s Exchange ) came about under the section of the Affordable Care Act called ObamaCare , and is the Marketplace where an individual can shop around and compare different insurance plans . Covered CA is the only place to get financial assistance with health insurance in California . The lower your income , the higher the financial assistance you get . You can pick and choose to see what best fits you and your family . ( If you have no income or your income is below a certain threshold , you will qualify for MediCal .) Not only can the financial assistance lower your premium , but can also lower your deductible and co-pays . For certain levels of income , not only are your monthly premiums low , but your out-of-pocket expenses for healthcare and medicine are quite low also .
THE METAL TIERS
Bronze : On average , your health plan pays 60 percent of your medical expenses , and you pay 40 percent .
Silver : On average , your health plan pays 70 percent of your medical expenses , and you pay 30 percent .
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 , coinsurance and deductibles . Individuals in these savings categories get the benefits of a Gold or Platinum plan for the price of a Silver plan . In the three categories of Enhanced Silver , the plan pays either 94 percent , 87 percent or 73 percent of expenses , with the enrollee responsible for the rest .
Gold : On average , your health plan pays 80 percent of your medical expenses , and you pay 20 percent .
Platinum : On average , your health plan pays 90 percent of your medical expenses , and you pay 10 percent .
In addition to the metal tiers , Covered California offers a minimum coverage plan for those who qualify .
Minimum coverage plan : If you ’ re under 30 , you may be able to buy an additional health insurance plan option called minimum coverage plan . These plans usually have lower premiums and mostly protect you from worst-case scenarios . Minimum coverage plans through Covered California cover three doctor visits or urgent care visits , including outpatient mental health / substance use visits , with no out-of-pocket costs , and free preventive benefits . All other services will be full price but at the negotiated in-network price , until you spend $ 6,850 , after which all in-network services are covered at 100 percent .
OFF EXCHANGE : If you do not qualify for any financial assistance , there is no need to purchase your plan through Covered CA . You can go directly to the insurance company or through an insurance agent to purchase a plan and the application is much shorter as you won ’ t have to supply a list of personal information on your household and income . There are also more plans available off exchange ; some insurance companies don ’ t want to participate on the exchange and they are not required to .
PEDIATRIC DENTAL PLANS are embedded on all plans through Covered CA and will offer supplemental dental coverage for adults in the 2016 plan year , through optional family dental plans .
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GILROY • MORGAN HILL • SAN MARTIN JANUARY / FEBRUARY 2016 gmhtoday . com