Complete individual and family medical plan , On-line quotation!
All individuals and families in California are required by state law to have health insurances. Open enrollment is the time of year when everyone can apply for an insurance plan. There is no limit on maximum amount of money for claims and can be insured with pre-existing health condition due to the high medical costs in the United States.
The Covered California Health Exchange is the government agency offering subsidized Obamacare insurance plans for eligible residents. Depending on your household size and income, you will be given a certain premium subsidy, and you can freely choose your prefer insurance company and plan benefits.
Off-Exchange Health Insurance is a plan that is purchased directly from an insurance company, or through a broker without applying for a government subsidy and paying the full premium payment.
| Minimum Coverage | Bronze 60 | Silver 70 | Gold 80 | Platinum 90 | |
|---|---|---|---|---|---|
| Annual Deductible | Individual $9,200 Family $18,400 |
Individual $5,800 Family $11,600 |
Individual $5,400 Family $10,800 |
Individual $0 Family $0 |
Individual $0 Family $0 |
| Annual Out of Pocket Maximum (Include Annual Deductible) |
Individual $9,200 Family $18,400 |
Individual $8,850 Family $17,700 |
Individual $8,700 Family $17,400 |
Individual $8,700 Family $17,400 |
Individual $4,500 Family $9,000 |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited |
| Doctor Visit Copay (Family / Internal) |
$0 per visit (1st 3 visits not subject to annual deductible, then subject to the deductible after that) |
$60 per visit | $50 per visit | $35 per visit | $15 per visit |
| Doctor Visit Copay (Specialist) |
$0 after the annual deductible | $95 per visit (1st 3 visits not subject to annual deductible, then subject to the deductible after that) |
$90 per visit | $65 per visit | $30 per visit |
| Acupuncture Visit Copay | $0 per visit (1st 3 visits not subject to annual deductible, then subject to the deductible after that) |
$60 per visit | $50 per visit | $35 per visit | $15 per visit |
|---|---|---|---|---|---|
| Urgent Care Visit Copay | $0 per visit (1st 3 visits not subject to annual deductible, then subject to the deductible after that) |
$60 per visit | $50 per visit | $35 per visit | $15 per visit |
| Emergency Room Visit Copay | $0 after the annual deductible | 40% after the annual deductible | $400 per visit | $330 per visit | $150 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Women's Preventive Care (Pap smear, Mammogram) |
$0 (Every two years) | $0 (Every two years) | $0 (Every two years) | $0 (Every two years) | $0 (Every two years) |
| Laboratory fee Copay | $0 after the annual deductible | $40 per visit | $50 per visit | $40 per visit | $15 per visit |
| X Ray/Ultrasound | 0% after the annual deductible | 40% after the annual deductible | $95 per visit | $75 per visit | $30 per visit |
| CT Scan/MRI Imaging | 0% after the annual deductible | 40% after the annual deductible | $325 per visit | $75 per Visit(HMO) 25%(PPO) |
$75 per Visit(HMO) 10%(PPO) |
| Inpatient Fee | 0% after the annual deductible | 40% after the annual deductible | 30% after the annual deductible | $350 Copay per day up to 5 days (HMO) 30% (PPO) |
$225 Copay per day up to 5 days (HMO) 10% (PPO) |
| Outpatient Fee | 0% after the annual deductible | 40% after the annual deductible | 30% | $130/procedure (HMO) 30% (PPO) |
$75/procedure (HMO) 10% (PPO) |
| Maternity Benefit (Inpatient) |
0% after the annual deductible | 40% after the annual deductible | 30% after the annual deductible | $350 Copay per day up to 5 days (HMO) 30%(PPO) |
$225 Copay per day up to 5 days (HMO) 10%(PPO) |
| Maternity Benefit (Outpatient) |
0% after the annual deductible | 40% after the annual deductible | 30% | $130/procedure (HMO) 30% (PPO) |
$75/procedure (HMO) 10% (PPO) |
| Ambulance | $0 after the annual deductible | 40% after the annual deductible | $255 per visit | $250 per visit | $150 per visit |
| Prescription Drug Fee （Tier 1/2/3/4） |
After the annual deductible | After $450 annual deductible | After $50 annual deductible | ||
| Tier 1: Generic | 0% | $17/prescription (deductible does not apply) | $18/prescription (deductible does not apply) | $15/prescription | $7/prescription |
| Tier 2: Preferred Brand | 0% | 40% (up to $500/prescription) | $60/prescription | $60/prescription | $16/prescription |
| Tier 3: Nonpreferred Brand | 0% | 40% (up to $500/prescription) | $90/prescription | $85/prescription | $25/prescription |
| Tier 4: Preferred Specialty | 0% | 40% (up to $500/prescription) | 20% (up to $250/prescription) | 20% (up to $250/prescription) | 10% (up to $250/prescription) |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
| Silver 94 | Silver 87 | Silver 73 | |
|---|---|---|---|
| Annual Deductible | Individual $75 Family $0 |
Individual $800 Family $0 |
Individual $4,750 Family $0 |
| Annual Out of Pocket Maximum (Include Annual Deductible) |
Individual $1,150 Family $2,300 |
Individual $3,000 Family $6,000 |
Individual $6,100 Family $12,200 |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited |
| Doctor Visit Copay (Family / Internal) |
$5 per visit | $15 per visit | $35 per visit |
| Doctor Visit Copay (Specialist) |
$8 per visit | $25 per visit | $85 per visit |
| Acupunture Visit Copay | $5 per visit | $15 per visit | $35 per visit |
|---|---|---|---|
| Urgent Care Visit Copay | $5 per visit | $15 per visit | $35 per visit |
| Emergency Room Visit Copay | $50 per visit | $150 per visit | $350 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Women's Preventive Care (Pap smear, Mammogram) |
$0 (Every two years) | $0 (Every two years) | $0 (Every two years) |
| Laboratory fee Copay | $8 per visit | $20 per visit | $50 per visit |
| X Ray/Ultrasound | $8 per visit | $40 per visit | $95 per visit |
| CT Scan/MRI Imaging | $50 per visit | $100 per Visit | $325 per Visit |
| Inpatient Fee | 10% | 20% | 30% |
| Outpatient Fee | 10% | 20% | 30% |
| Maternity Benefit (Inpatient) |
10% | 20% | 30% |
| Maternity Benefit (Outpatient) |
10% | 20% | 30% |
| Ambulance | $30 per visit | $75 per visit | $250 per visit |
| Tier 1: Generic | $3/prescription | $5/prescription | $16/prescription |
| Tier 2: Preferred Brand | $10/prescription | $25/prescription | $55/prescription |
| Tier 3: Nonpreferred Brand | $15/prescription | $45/prescription | $85/prescription |
| Tier 4: Preferred Specialty | 10% (up to $150/prescription) | 15% (up to $150/prescription) | 20% (up to $250/prescription) |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
Only provides an HMO plan for individual and family health insurance in Southern California, and an EPO plan for Northern California. The premiums may be very competitive in certain areas with a decent range of medical network.
More ApplyProvides HMO and PPO plans. Blue Shield PPO plan has the largest contracted medical network, including UCLA, City of Hope, HOAG and other hospitals in Greater Los Angeles area.
More ApplyProvides HMO and PPO plans. The premiums of PPO plan are very competitive but smaller contracted medical network.
More ApplyOnly provides HMO plan. It is a membership-based medical group, and its insurance can only be used in their medical centers. The advantage is that most medical treatments can be done in the same Kaiser medical building which is more convenient.
More ApplyThe United States is a country with the most expensive medical expenses in the world. A general outpatient, surgery or emergency charge can cost hundreds to thousands of dollars. Health insurance protects you from unexpected high medical costs.
The penalty for not having coverage the entire year will be at least $900 per adult and $450 per dependent child under 18 in the household when you file your state income tax return.
After the implementation of Affordable Care Act (Obamacare), major insurance companies can only accept the purchase and change of health insurance plans during the open enrollment period which from November 1st of each year to the end of January 31st of the following year. The enrollment end period can be varies if there is a special circumstance.
You can apply for a health plan outside open enrollment (or make changes to your current plan) if you’ve experienced one of these qualifying life events, usually within the last 60 days. The effective date of the insurance is the 1st of the following month after submitting the application.
Medi-Cal is California's Medicaid program. Medi-Cal gives people with low incomes access to health services without paying insurance premiums and medical expenses. However, the contracted medical network is very limited and usually the waiting period of the medical appointment is longer.
*In some cases, monthly premium for children under 18 yrs old may required.
Subsidized health insurance and Medi-Cal insurance cannot exist at the same time. If you currently hold a Medi-Cal insurance, you need to contact Medi-Cal Office in your county to cancel your Medi-Cal insurance, even if it is not during the open enrollment period of health insurance. After the Medi-Cal insurance is cancelled, then it is eligible as special enrollment period. You can apply for the subsidized health insurance within 60 days. After the application is submitted, it will be effective on the 1st of the following month.
Covered California refers to the standards in the Federal Poverty Level to provide premium subsidies according to different household sizes and adjusted gross income on the 1040 tax form. The variety Silver plans are depend on the income ranges.
Only California taxpayer residents are eligible to apply for the subsidized health insurance through Covered California. For new immigrants, a social security number and legal immigration status documents are required (Employment Card, Permanent Resident Card, Certification of Naturalization, or passport). Your pay stub or tax return is required as proof of income.
Different insurance companies have different contracted medical network. Usually, a larger medical network will have relatively higher premiums. The premiums in different regions are also different due to medical claim ratio.
HMO plan requires you to designate a Primary physician and a medical network. Except for emergency medical treatment, you need to make an appointment with a Primary physician first, and the Primary physician will determine whether it is necessary to refer you to a specialist or make an appointment for surgery. The medical costs will not be covered outside the contracted medical network.
PPO plan allows you to directly make an appointment with a Specialist doctor without a referral from a Primary physician, and larger contracted medical network. Some of the medical costs will be covered under non-contracted medical network.
EPO is between HMO and PPO. EPO is easier to make an appointment with a Specialist doctor without referral from a Primary physician. It is more convenient than HMO, but there is no coverage for non-contracted medical network, and contracted medical network is smaller than PPO plans.