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2020 Health Insurance - Side by Side Comparison

Check out this great video and learn about various health plans available in 2020 in California

Learn More About Health Insurance


What is SEP- Special Enrollment Period?

 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

How can I find a Certified Insurance Agent to help me with CoveredCA?

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.  

How to correct information on form 1095-A?

 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 the health insurance subsidy / tax credit?

  • 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.