Not covered by a group health plan? We can help you find the perfect plan to meet your individual needs from HMOs to high deductible PPOs or EPOs. Let us help find the ideal fit for you.
Health Maintenance Organization (HMO)
A HMO requires you to choose a Primary Care Physician (PCP). You will need to see your PCP first for most healthcare needs. Your PCP will refer you to a specialist in their medical group if they think it is necessary.
Preferred Provider Organization (PPO)
A PPO has a network of providers that you can access with better benefits, but also allows you to use medical providers outside the plan’s network with greater individual cost sharing without a referral.
Exclusive Provider Organization (EPO)
An EPO has a network of providers that you can access without a referral. It is more flexible than a HMO plan and less flexible than a PPO plan.
Starting in 2014, individual plans will have some different characteristics:
- All plan will be guaranteed issue regardless of any pre-existing medical conditions.
- Health plans will be categorized by metal tiers: Bronze 60%, Silver 70%, Gold 80% and Platinum 90%.
- Due to Healthcare reform most Americans will be required to have public coverage such as Medi-Cal or Medicare or private health insurance…or pay a fine.
- Medi-Cal Assistance: The State of California will cover people under age 65, including people with disabilities, with incomes of less than 138% of the federal poverty level. The coverage is free for those who qualify.
- Premium Assistance and Cost-Sharing Subsidies: These are available through Covered California to help lower the cost of your health coverage when you meet certain income requirements and do not have affordable health insurance from an employer or a government program that meets minimum coverage requirements. To find out more about how the premium assistance and cost-sharing subsidies work, please visit the Shop and Compare tool on www.coveredca.com.
Whether you are eligible for premium assistance or not, let us help find the best health plan for you!