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What Health Insurance Plan
Is Right For You?
We don’t charge anything for our advice! We want to help you find the best and most affordable health care solutions to meet your personal needs.
Finding the right health insurance plan at an affordable cost can be complicated and time-consuming. There are a large number of individual and family health insurance providers and a variety of plans to choose from, including HMO’s and PPO’s. It’s important to select the best 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. Because our fees are paid by the insurance companies we work with, 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. We are also authorized agents for Covered California.
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 to choose from. 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 healthcare service providers. Your insurance premiums will be higher than other plan types, but you’ll have greater selection and a larger network of 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 off the exchange, 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 October 15th of each year and goes through January 15th. 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.
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.