How to Maximize Your Health Coverage with Covered California

As Golden State residents, you and your family can access very affordable — and perhaps even free — quality health care through the state’s Covered California health insurance marketplace. Many residents pay less than $10 a month. 

But to take full advantage, here’s how you can maximize Covered California coverage to protect yourself and the ones you love. But first, make sure you have a basic understanding of this important state program. 

What Is Covered California, and How Does It Work? 

Understanding Covered California is important before you dive in. The program was launched in 2013 under provisions of the federal government’s Affordable Care Act (ACA). Its purpose was, and still is, to provide a highly affordable healthcare marketplace for individuals, families, and smaller businesses in the state. Health insurance subsidies are available to cover some or even all of the costs for those who qualify, depending on income and other factors. 

In select areas or throughout the state, you can choose brand-name plans from Anthem Blue Cross, Kaiser Permanente, Aetna, UnitedHealthcare, and other providers. Enrollees can access coverage for emergency and preventive care, vision, dental, maternity and newborn care, pharmaceutical services, mental health, and other areas of care. 

When Californians enroll in Covered California, they provide a financial snapshot that will determine what they’ll pay for their coverage — sometimes just $10 a month, or even less. 

Key Tips for Maximizing Your Health Coverage Through Covered California 

Covered California is about consumer choice. You’ll have at least two plan options, wherever you live, and four levels, or tiers, of coverage based on how much and how you choose to pay. 

Choosing the Right Health Plan and Tier Based on Your Needs 

When shopping on the Covered California website, you’ll see the health plans that are available in your area. Compare their features and benefits to see which seems ike the best choice for you or your family. 

You’ll also select a tier of coverage: Platinum, Gold, Silver, or Bronze. The tiers determine your cost-sharing arrangement. 

For instance, Platinum plans cost the most in monthly premiums, but charge members the lowest out-of-pocket rates when they seek healthcare services. Bronze plans, on the other hand, cost the least in premiums, but members must pay the most in out-of-pocket expenses when they receive covered services. Gold and Silver tier plans offer cost-sharing arrangements that are between the two extremes. 

A knowledgeable Acceptance agent can help you crunch the numbers and maximize health coverage by determining which plan and tier best fit your wallet and coverage needs – for free. 

How to Use Covered California’s Subsidies to Lower Your Cost of Coverage 

No one will ever be refused California health coverage because they can’t afford to pay for their health plan. You can use Covered California health insurance subsidies to bring coverage well within your range of affordability. 

In fact, almost 90% of enrollees receive some level of financial assistance to pay for their Covered California plan. 

When you register for coverage — whether by phone, in person, or online — you’ll be asked questions to determine what you can afford to pay. Simply answer the questions and find the rate you’ll be asked to pay in monthly premiums. You’re almost sure to be pleasantly surprised. 

How to Get the Most Out of Your Health Plan Once You’re Enrolled 

Your Covered California healthcare plan is a valuable asset. It will help protect your health and the health of your family without costing more than you can afford to pay. Here’s how to use your coverage wisely. 

Using Preventive Care Services Without Paying Out of Pocket 

It’s in the financial best interests of health insurers to keep their members as healthy as possible for as long as possible. That’s why they offer certain services at no cost to you, even if you would normally be responsible for a deductible or copay. 

The list of no-cost preventive care services often includes many vaccinations, routine checkups for the young, tests for some cancers and medical conditions, contraceptive services, and others. 

Take advantage of these cost-free services whenever they’re offered. They can keep you and your loved ones in better health at absolutely no cost to you. 

Understanding Deductibles, Copays, and Your Network of Health Service Providers 

In order to gain maximum health coverage at the lowest possible cost to you, it pays to know the health insurance terminology that will affect your plan. Here are three concepts particularly worth knowing. 

Deductible 

Your deductible is the dollar amount that you agree to pay before your insurance plan covers the rest of the cost of a claim. The higher your deductible, the less your plan will cost in monthly premiums. On the other hand, you’ll have to pay more out of pocket on an annual basis before your insurance company kicks in to cover costs. 

If you agree to a lower deductible, your premiums will be higher, but you’ll pay less out of your own pocket before your insurer assumes payment responsibility. 

It’s a balancing act between paying more upfront when services are needed or paying more in premiums. If you work with a knowledgeable health insurance agent at Acceptance, they can help you run the numbers and determine which deductible level works best for you. This is a free service you can access by calling 877-423-1534. 

Health Insurance Copay 

A copay is the dollar amount that health plan members must pay on a per-service basis. Copay amounts for Covered California plans are usually no more than $10 or $15. 

Only some plans have copays for certain healthcare services, and the amount might vary depending on the tier of the plan you’re on — Platinum, Gold, Silver, or Bronze. The tiers with lower monthly premiums, such as Bronze, tend to have higher copays than tiers that charge more in premiums but less out of pocket. 

By carefully reviewing the details of the plan you’re considering, you can find out if there are copays for any services you’ll need, and how much they’ll cost based on your tier. 

Network of Medical Professionals and Labs

Your network is the group of healthcare service providers — doctors, hospitals, and clinics — that will provide your services. It’s critical that you know the providers that are and are not in your network, since you might only receive partial financial help from your plan or none at all if you obtain care from an out-of-network provider (except in an emergency). 

Different plans have different types of network agreements and cost structures. For instance, an HMO tends to cost less to members, but it’s the most restrictive in terms of network services. If you go to a service provider out of your HMO network, except in an emergency, the service won’t be covered, and you’ll have to pay for it out of your own pocket. 

A PPO, on the other hand, has a much less restrictive network, but it costs more. So you’ll have a greater choice of service providers, but your premiums will be more expensive. An EPO is the middle ground in terms of options and costs. 

As with your deductible, selecting a network is a cost-balancing act. What can you afford, and do you need services that aren’t in all networks? Those are some of the questions you must ask yourself – or a knowledgeable Acceptance agent. 

How Acceptance Insurance Can Help You Maximize Your Covered California Coverage 

Chances are, you still have a lot of questions about Covered California enrollment procedures, costs, options, and plan details. That’s to be expected. At Acceptance Insurance, we have answers. 

Our knowledgeable health insurance brokers have helped countless Californians access the plan and figure out how to use Covered California health coverage to their maximum benefit at the lowest possible cost. This is a free service. 

We’ll show you how to obtain the best health insurance plans for you and your loved ones, and make decisions on deductibles, health insurance tiers, and networks that are in your best interest. 

Simply call us at 877-423-1534 and we’ll be happy to walk you through all of your choices and options, at no cost to you.