Investing in a comprehensive health insurance plan is more than just smart financial planning, it’s also necessary to comply with state and federal regulations. Health insurance, whether it be a HMO, PPO or EPO, gives you the financial protection you need to pursue both emergency and preventive medical care.
What does health insurance cover?
Health insurance coverage will be determined exclusively by the type of plan you’re enrolled in. In California, different programs follow different sets of rules. The California Department of Insurance regulates the available plans, and typically individuals and family gain coverage from their employer or through the Covered California marketplace. According to California state law, any policy issued after January 1st, 2014 is required to offer essential health benefits, including:
- Hospital care
- Visits to a primary care doctor and specialists
- Outpatient procedures, like surgery
- Laboratory tests and diagnostic services, like x-rays and mammograms
- Pregnancy and newborn care
- Preventive and routine care, like vaccinations and checkups
- Mental health care
- Emergency and urgent care
- Rehabilitation therapy, such as physical, occupational and speech therapy
- Some home health or nursing home care after a hospital stay
- Prescription drugs
- Substance abuse treatment
- Oral and vision care for children
While these benefits are considered “essential”, they are not free of charge. You may have a co-pay or a coinsurance cost associated with the above benefits. Some health plans may offer additional health or vision coverage for purchase. As of June 2018, all residents must either obtain health insurance or pay a tax penalty. To avoid the penalty at tax time, each individual must show that they maintained the minimum essential coverage in any given year.
No two plans are exactly alike. Some individuals may be comfortable with a higher deductible to lower monthly premiums, whereas others may require frequent care at a lower deductible. Your health needs should always dictate your plan selection.
Why do I need a health insurance broker?
Whether you’ve never been covered before or whether you’re simply experiencing an unusual lapse, working with a health insurance broker will help you ensure that you’ve selected the best policy for your needs and lifestyle. At Frankel & Associates, we’ll partner with you to help assess your unique risks. Next, we evaluate possible policies based on a variety of factors such as premium costs, pre-existing conditions, family size and the providers previous claims response history. As a result, you’re able to save time and money by considering only plans that meet your requirements!