Individual Health Insurance

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.

On-Exchange Health Insurance

  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.

Off-Exchange Health Insurance
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Minimum Coverage Bronze 60 PPO Silver 70 PPO Gold 80 PPO Platinum 90 PPO
Annual Deductible Individual $8,700
Family $17,400
Individual $6,300
Family $12,600
Individual $3,700
Family $7,400
Individual $0
Family $0
Individual $0
Family $0
Annual Out of Pocket Maximum
(Include Annual Deductible)
Individual $8,700
Family $17,400
Individual $8,200
Family $16,400
Individual $8,200
Family $16,400
Individual $8,200
Family $16,400
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)
$65 per visit
(1st 3 visits not subject to annual deductible, then subject to the deductible after that)
$35 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)
$70 per visit $65 per visit $30 per visit
Urgent Care Visit Copay $0 per visit
(1st 3 visits not subject to annual deductible, then subject to the deductible after that)
$65 per visit
(1st 3 visits not subject to annual deductible, then subject to the deductible after that)
$35 per visit $35 per visit $15 per visit
Preventive Care $0 (Once Per Year) $0 (Once Per Year) $0 (Once Per Year) $0 (Once Per Year) $0 (Once Per Year)
Laboratory fee Copay 0% after the annual deductible $40 per visit $40 per visit $40 per visit $15 per visit
Inpatient Fee 0% after the annual deductible 40% after the annual deductible 20% after the annual deductible $600 Copay per day up to 5 days (HMO)
20% (PPO)
$250 Copay per day up to 5 days (HMO)
10% (PPO)
Outpatient Fee 0% after the annual deductible 40% after the annual deductible 20% $300/procedure (HMO)
20% (PPO)
$100/procedure (HMO)
10% (PPO)
Prescription Drug Fee
(Tier 1/2/3/4)
0% after the annual deductible $18/40% after $500 drug deductible
( $500 out of pocket maxmium per drug per calendar year)
$15/$55/$85/20% after $10 drug deductible
( $250 out of pocket maxmium per drug per calendar year)
$15/$55/$80/20%
($250 out of pocket maxmium per drug per calendar year)
$5/$15/$25/10%
($250 out of pocket maxmium per drug per calendar year)
Acupuncture Visit Copay $0 per visit
(1st 3 visits not subject to annual deductible, then subject to the deductible after that)
$65 per visit
(1st 3 visits not subject to annual deductible, then subject to the deductible after that)
$40 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 $350 per visit $150 per visit
Ambulance $0 after the annual deductible 40% after the annual deductible $255 per visit $250 per visit $150 per visit
Maternity Benefit
(Inpatient)
0% after the annual deductible 40% after the annual deductible 20% after the annual deductible $600 Copay per day up to 5 days (HMO)
20%(PPO)
$250 Copay per day up to 5 days (HMO)
10%(PPO)
Maternity Benefit
(Outpatient)
0% after the annual deductible 40% after the annual deductible 20% $300 per Visit (HMO)
20%(PPO)
$100 per Visit (HMO)
10%(PPO)
X Ray/Ultrasound 0% after the annual deductible 40% after the annual deductible $85 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 $150 per Visit(HMO)
20%(PPO)
$75 per Visit(HMO)
10%(PPO)
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
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Plan Benefits
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Silver 94
HMO/PPO/EPO
Silver 87
HMO/PPO
Silver 73
HMO/PPO
Insurance Carriers Blue Shield / Health Net / Kaiser Permanent / Blue Cross / Oscar Blue Shield / Health Net / Kaiser Permanent / Blue Cross / Oscar Blue Shield / Health Net / Kaiser Permanent / Blue Cross / Oscar
Annual Deductible Individual $75
Family $150
Individual $800
Family $1,600
Individual $3,700
Family $7,400
Annual Out of Pocket Maximum
(Include Annual Deductible)
Individual $800
Family $1,600
Individual $2,850
Family $5,700
Individual $6,300
Family $12,600
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 $70 per visit
Urgent Care Visit Copay $5 per visit $15 per visit $35 per visit
Preventive Care $0 (Once Per Year) $0 (Once Per Year) $0 (Once Per Year)
Laboratory fee Copay $8 per visit $20 per visit $40 per visit
Inpatient Fee 10% after the annual deductible 15% after the annual deductible 20% after the annual deductible
Outpatient Fee 10% 15% 20%
Prescription Drug Fee
(Tier 1/2/3/4)
$3/$10/$15/10%
($150 out of pocket maxmium per drug per calendar year)
$5/$25/$45/15%
($150 out of pocket maxmium per drug per calendar year)
$15/$55/$85/20% after $10 drug deductible
($250 out of pocket maxmium per drug per calendar year)
Acupuncture Visit Copay $5 per visit $15 per visit $35 per visit
Emergency Room Visit Copay $50 per visit $150 per visit $400 per visit
Ambulance $30 per visit $75 per visit $250 per visit
Maternity Benefit
(Inpatient)
10% after the annual deductible 15% after the annual deductible 20% after the annual deductible
Maternity Benefit
(Outpatient)
10% 15% (deductible waived) 20%
X Ray/Ultrasound $8 per visit $40 per visit $85 per visit
CT Scan/MRI Imaging $50 per visit $100 per visit $325 per visit
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
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Covered CA

Anthem Blue Cross:

  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 Apply

Blue Shield:

  Provides 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 Apply

Health Net:

  Provides HMO and PPO plans. The premiums of PPO plan are very competitive but smaller contracted medical network.

More Apply

Kaiser Permanente:

  Only 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 Apply

Oscar:

  Is a newly joined insurance company in California. It provides an EPO plan with a competitive premium but narrower contracted medical network.

More Apply

  The 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 $800 per adult and $400 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.

    1. Gained U.S. citizenship or lawful presence
    2. Had a baby or adopted a child
    3. Moved to/within California
    4. Lost existing health coverage, including job-based individual plans
    5. Got married or divorced
    6. Turned 26 and lost coverage through a parent’s plan
    7. Death in the family
    8. Lost eligibility for Medicaid/Medi-Cal
    9. Returned from active-duty military service
    10. Released from incarceration

  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 the Department of Social Services 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.