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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)

When is the open enrollment to get health insurance for 2020? 

What is the maximum income to qualify for CoveredCA?  

Can legal immigrants receive Medi-Cal benefits or apply for a CoveredCA health plan?

What is Covered by Dental Insurance?

Can I get subsidized health plans in the CoveredCA if my employer also provides health insurance as an employee benefit? 

Do I have to pay a penalty if I don’t have health insurance in 2018 or 2019? do i need form 1095-A? 

Do I have to pay a penalty if I don't have health insurance in year 2020? 

What are exemptions from health insurance tax penalty and who qualifies for exemption? 

What are 1095 Tax Forms for Health Care 1095 A, 1095 B, 1095 C? 

Why is Health Insurance expensive? 

What is HSA Account? 

What is EPO, PPO, HMO?  

How to find a health insurance broker? 

What is Co-payment?

What is Co-insurance?

What is Medical Deductible? 

What is the difference of PPO and HMO?

What is SEP?

What do you need to know about dental insurance?

What do you need to know about vision insurance?

How to save money on doctor’s visits? 

What is covered by Kaiser plan?  

What is covered by BlueShield plan? 

What is covered by Valley Health PLan? 

 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 

• The subsidy or the tax credit is the amount that you receive (not directly), which helps you pay for health insurance. The subsidy depends on the income (your adjusted gross income), family size and your zip code. Here is the income table for the year 2018

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. 

• After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.
• Some plans have separate deductibles for certain services, like prescription drugs.
• Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members
• Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles.

 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. 

For example: 

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.

Deductible: $3,000
Coinsurance: 20%
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. 

For example:
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.

• Copayments (sometimes called "copays") can vary for different services within the same plan, like drugs, lab tests, and visits to specialists.
• Generally, plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.