Health Insurance

Open Enrollment Ends May 15, 2021

“Your health account, your bank account, they are the same thing. The more you put in, the more you can take out."

– Jack Lalanne

Open enrollment for 2021
will run between
October 15, 2020 to January 31, 2021,
both on and off-exchange.

California will have a State-based premium subsidy for 2020-2023 for enrollees’ income up to 600% of the poverty level compared to 400% until 2019. Thus, more people will be eligible for a premium subsidy.  

California will have an individual mandate starting in 2020. The penalty for not having health insurance will be a minimum of $695 per uninsured adult and $347 per child OR 2.5% of the annual household income; whichever is greater.

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Individual Health Insurance

Individual Health Insurance - Child Only

Individual Dental Insurance

Group Health
Insurance

HMO (Health Maintenance Organization) is generally the most affordable, but least flexible network type.

Key concepts of HMO 
  • You are required to select a primary care physician who is your first stop for health care needs.  
  • A referral from your primary care physician is needed to see a specialist.
  • seeing a doctor outside of the network or without a referral will incur out-of-pocket unless it is a true medical emergency. 
  • The physician network is local.   

PPO (Preferred Provider Organization) is generally the most flexible, yet most expensive network type.

Key Concept of PPO: 
  • Any physician or specialist within the network is available for you. 
  • For in-network providers, you only pay for a portion of the bill based on your coverage structure. 
  • Out of network providers will incur a larger out-of-pocket co-payment. 
  • Out-of-state providers are available in-network  

EPO (Exclusive Provider Network) is a hybrid of a HMO and a PPO.

Key Concepts Of An EPO:
 
  • EPOs are more flexible than an HMO and are typically less expensive than a PPO
  • For in-network providers, you only pay for a portion of the bill based on your coverage structure.
  • Like a PPO, you do not need a referral to get care from a specialist.

Note: Once open enrollment ends, only individuals with the following qualifying life events will be able to enroll

Loss Of Health Coverage

  • Loss Of Health Coverage
  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP

  • Turning 26 and losing coverage through a parent’s plan

  • Changes in household

    • Getting married or divorced

    • Having a baby or adopting a child

    • Death in the family

  • Changes in residence

    • Moving to a different ZIP code or county

    • A student moving to or from the place they attend school

    • A seasonal worker moving to or from the place they both live and work

    • Moving to or from a shelter or other transitional housing

  • Other qualifying events

    • Changes in your income that affect the coverage you qualify for

    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

    • Becoming a U.S. citizen

    • Leaving incarceration (jail or prison)

    • AmeriCorps members starting or ending their service

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