Finding the right, affordable health insurance plant can be complicated and time-consuming. There are a large number of individual and family health insurance providers and plans to choose from. You want the best health coverage options for your needs and budget.

You don’t have to do all of the research on your own!

Benefits by Design is a full service health insurance brokerage, offering custom-tailored, affordable individual and family health insurance plans. 

Our fees are paid by the insurance companies, so our services are provided at no charge to you. We can easily and quickly help you select and get set up with the right type of medical insurance policy for your needs. We offer private health insurance from California’s most respected insurance providers (off exchange.) We are also authorized agents for Covered California (on exchange.)

Common Questions With Answers 

 

What is an HMO (Health Maintenance Organization)?

An HMO health insurance plan gives you access to the doctors and hospitals within the plan’s network. Care under an HMO plan is covered only if you see an in network provider, except in case of an emergency. You also will need to select a primary care physician and have your care directed by your doctor.  Most specialists require a referral from your primary care doctor before you see them. HMO plans can be a great choice and tend to cost less than PPO plans.

 

What Is A PPO (Preferred Provider Organization)?

PPO plans tend to have a larger provider network of doctors. A PPO health insurance plan does not require you to select a primary care physician and see that physician first before seeking specialized care. Instead, you can receive care from any doctor. If you go to a doctor outside of the PPO network it may cost you more and you may accumulate costs toward a separate out of pocket maximum.  PPO plans are preferable if you want flexibility in your health care service providers.

 

What Is Covered California?

Covered California enables you to get affordable health insurance under the Patient Protection and Affordable Care Act. Sometimes called Obamacare, this type of plan includes federal premium assistance to help you buy health insurance that works for your income and budget. Benefits By Design is an authorized agent for Covered California.

 

Do I need to buy a plan through Covered California?

It depends. You may want to enroll through Covered California if you think you may qualify for a subsidy to supplement your premium payment. The rates are the same for all products on the exchange (Covered California), or if you purchase directly from an insurance company.

 

When can I buy a new health insurance plan?

Open enrollment for individual health insurance plans begins on November 1st each year and goes through  December 31st. Sometimes the open enrollment is extended through the end of January.. Coverage begins January 1st if you enroll by December 15th.  If you enroll after December 15th and before January 15th, your coverage will be effective on February 1st.

 

Can I buy health insurance outside of the open enrollment period?  

Yes, if you’ve had a certain life event, including: losing your current health coverage, moving, getting married, having a baby, or adopting a child. Having one of these situations may be considered a qualifying event and it may entitle you to a Special Enrollment Period (SEP). The health insurance company will require documentation to support the life event. Otherwise, you will need to wait for the next Open Enrollment Period.

If you qualify for a Special Enrollment Period, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you will have to wait until the next Open Enrollment Period to apply.

You can enroll in Medicaid and the Children’s Health Insurance Plan (CHIP) any time of year, whether you qualify for a Special Enrollment Period or not.

How can I tell if I might qualify for a subsidy on Covered California? 

Go to the Covered California website and click on Shop and Compare in the upper right hand side of the menu bar.  The brokers at Benefits by Design are familiar with the website and the guidelines for determining eligibility for subsidies, so don’t hesitate to ask us about your situation.

We can help you understand::

• Health Savings Account compatible plans with a High Deductible Health plan
• What is the difference between a Bronze, Silver, Gold or Platinum plan
• Which plans do my doctors participate in
• How to compare and choose one plan over another

No questions are dumb questions!

 

What Does A Dental Plan Cover?

A dental insurance plan typically covers basic dental services, like routine checkups, cleaning and X-rays. Some dental insurance plans reduce the cost of any dental services you may need, for example, a dental crown or cavity filling.

 

What Do Vision Plans Cover?

A vision insurance plan reduces your costs for routine eye exams and prescription eyewear (eyeglasses and contact lenses). Some vision plans also offer discounts on elective vision correction surgery, such as LASIK.

Let Benefits by Design help you find the right type of individual and family health insurance for your situation and needs. We are a full service individual and family health insurance broker.

 

To learn more, please call: (760-696-3573)

 

We have offices in Northern San Diego County in Carlsbad and in Northern California in Larkspur in Marin County. We serve the entire state of California.

We can meet by telephone, Zoom meeting or in person in our Carlsbad office. These days help is just a phone call or a Zoom meeting away.