California Lic. # OM24022
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Frequently Asked Questions about health insurance:
(we have all of this questions answered on our YouTube Channel and more resources. Please visit us & Subscribe to us on YouTube and stay up to date on this information)
Check out this great video and learn about various health plans available in 2020 in California
SEP is the special enrollment period- it allows anyone to apply for health insurance outside of the open enrollment. Here are the SEP reasons:
- Lost or will soon lose my health insurance
- Permanently moved to/within California
- Had a baby or adopted a child
- Got married or entered into domestic partnership
- Returned from active duty military service
- Gained citizenship/lawful presence
- Member of a Federally Recognized American Indian or Alaska Native Tribe
It is quite easy. You can find an agent by searching "Find Help Near You" on CoveredCa web-site. For example, you can search for Diana Polyakov, a Certified Insurance Agent, provide your zip code (make sure to increase the search distance). Certified Insurance Agents are trained to be fair, accurate and impartial when representing Covered California plans to consumers. Agents can never charge handling, set-up or consultation fees to assist consumers with their Covered California enrollment.
Here is the form that you will have to file to correct or dispute information on form 1095-A- Dispute Form 1095-A for Covered California Consumer
What is a Deductible?
The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
*Please note NOT ALL procedures are subject to the deductible, so check your summary of benefits.
Many plans pay for certain services, like a checkup or disease management programs, before you've met your deductible.
What is Co-Insurance?
Co-insurance is the percentage of costs of a covered healthcare service you pay (for example 20%) after you've paid your deductible. Typically the coinsurance is a percentage.
Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.
If you've paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
If you haven't met your deductible: You pay the full allowed amount, $100.
Example of coinsurance with high medical costs
Let's say the following amounts apply to your plan and you need a lot of treatment for a serious condition. Allowable costs are $12,000.
Out-of-pocket maximum: $6,850
You'd pay all of the first $3,000 (your deductible).
You'll pay 20% of the remaining $9,000, or $1,800 (your coinsurance).
So your total out-of-pocket costs would be $4,800 — your $3,000 deductible plus your $1,800 coinsurance.
If your total out-of-pocket costs reach $6,850, you'd pay only that amount, including your deductible and coinsurance. The insurance company would pay for all covered services for the rest of your plan year.
Generally speaking, plans with low monthly premiums have higher coinsurance, and plans with higher monthly premiums have lower coinsurance.
What is a Co-payment?
A fixed amount (for example $20) you pay for a covered health care service after you've paid your deductible. Generallyit s a fixed dollar amount.
Let's say your health insurance plan's allowable cost for a doctor's office visit is $100. Your copayment for a doctor visit is $20.
If you've paid your deductible: You pay $20, usually at the time of the visit.
If you haven't met your deductible: You pay $100, the full allowable amount for the visit.