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Understanding California Medical Insurance

If youíve had the pleasure of running some quotes through our instant quoting engine at youíve found a tremendous amount of powerful information at your fingertips.  But, even when using the best quoting tools youíll need to understand a few key terms and have the ability to use this knowledge to make the best decision possible for you and your family.

Letís start with some of the main areas of consideration:

Office Co-Pay-   It could be $5, $10, $20, or sometimes even $50 or not included at all these days. This is the amount you pay out of pocket which is a flat fee for typically consultation at a physicianís office.  If you see a $$$= dollar sign in your quote or plan benefit description it typically means you donít have to pay the planís general medical deductible for the office visit consultation.  If you see a % percentage listed as the office visit benefit it typically means you have to pay the plan general medical deductible first, and then you pay the percentage listed for the office visit consultation.  Also, other treatments received at the office visit are usually not covered within the planís co-pay.

When making a decision on plan type count how many times you and your family members go to the doctorís office per year and donít get hung up on the co-pay amount.  It doesnít make sense to buy a $10 co-pay plan because thatís what you had at your last job if the plan costs $500 more per month and you visit the doctor once per year.

Deductible-        The planís general medical deductible is another key factor in determining cost of the monthly premium of the plan and youíre out of pocket risk on medical expenses.  The planís deductible is the amount you pay for certain medical expenses before the insurance plan kicks in and helps you with the bills.  You receive the insurance carrierís negotiated rate for services even while paying 100% of the expenses towards deductible.  Usually bills like hospital, surgery, MRI, Emergency Room, and non routine lab will apply to deductible.  Or, typically anywhere you see a percentage listed for the benefit it means you have to pay the deductible first, and then you pay the percentage listed after deductible is paid.  Commonly youíll see office visits and prescription drugs waived from the planís general medical deductible.

Prescription Drugs or RX-             The third major category of cost/benefit consideration is prescription drugs.  When purchasing a new health plan or evaluating a change itís important to understand your usage currently and the actual costs of the prescription drugs you are taking.  But, itís also important to understand what prescription benefits are there for you if needed.  Many plans will strip the benefits for Brand drug coverage in an attempt to reduce the premium costs, but so many of the advancements in medicine today are manifested in prescriptions and the costs out of pocket can be astronomical.  We recommend leaving brand drug coverage in your plan as a benefit one way or another, even if it applies to your general medical deductible.  This way if you have to take a medication one day which costs several thousand dollars you have coverage waiting for you. 

To get a picture of the options visit our instant quoting engine today or contact us!


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