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Comparing Plan Choices
Applicants will have many options to compare when shopping in the Covered CA marketplace.
- Steps for selecting health insurance through Covered CA:
- Determine eligibility for APTC, CSR (Silver plans with better benefits), and/or MC
- Compare plans, networks, and prices (if enrolling in a Covered CA health plan)
- Choose the plan category, taking into consideration how often the client will use healthcare services and the amount of out-of-pocket expenses versus monthly premiums.
- Select a health plan
- Select the Bronze, Silver, Gold or Platinum metal tier.
- Choose the preferred health plan available in the region.
- Enroll
Although an applicant is enrolled in a health plan, he/she must pay the monthly premiums to receive actual healthcare coverage.
Premiums vs. Out-of-Pocket Costs
An applicant needs to make the decision of higher premium and lower out-of-pocket cost or a lower premium and higher out-of-pocket cost. A plan that covers more of a person's healthcare costs and helps keep out-of-pocket costs low will have a higher monthly premium; this type of plan is more beneficial to applicants that plan on frequent doctor visits throughout the year. Whereas, a plan with a low monthly premium will have higher out-of-pocket costs (in copayments and deductibles) when and if services are used; this type of plan may be more beneficial to a client that does not intend on using the health services often throughout the year.
Plan Structure
Applicants signing-up for a QHP (unsubsidized coverage) have the flexibility to select one plan for all household members, choose a different plan for each member, or custom-group specific individuals in to a plan.
Doctor Selection
All health insurance companies offered through Covered CA have online network directories available on their websites.
HMO
Clients choose a PCP when they enroll for coverage. There is a place on the application to enter the doctor's name. If the client does not select a PCP when they enroll, the organization providing health coverage will assign one to them based on their address.
PPO, EPO, and Other Plans
Clients who select a PPO, EPO or other non-HMO plan can visit doctors or hospitals that are either in or out of the plan's network. Clients do not have to choose a doctor when they apply for coverage.
However, the amount they will pay out of pocket may be lower if they use a doctor that is in-network.
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