Let's take a look at the Health Insurance
Coverage for year 2018 and will explore the plans offered by Blue Shield of California
In 2018 Blue Shield of
California offers plans on exchange and off the exchange. They have PPO plans
and the HMO Trio plan. Their HMO Trio plans are relatively new, so I’ll go over
in more details and provide specifics for this type of plan later on in the
video.
Also, I will have specific
summary of benefits for all of the plans offered by Blue Shield. I will post
links under this video.
If you have a specific
question, or would like to get an exact cost estimate for your plan, or you
just need a friendly advise, please feel free to reach me directly anytime. I
am an independent insurance agent in California. I also work with CoveredCa and
will be able to help you with selecting a low cost or subsidized health
insurance plan.
Before proceeding with the
video I also want to clarify a few things. As of today, the ACA (affordable
care act) is the law of the land. That means that consumers must select a
health plan during open enrollment, which is Nov. 1, 2017 through Jan. 31,
2018. (if you apply through CoveredCa). The federal open enrollment is shorter
and it ends on Dec. 15, 2017. Also, the plans presented in this video are
individual plans offered in California.
As I promised, I’ll go
over the new Trio HMO plans.
Obviously this is an HMO type
of plan, so you have to plan accordingly and use only in network providers. But
planning ahead might save you lots of money! Compared to the PPO plan the Trio
HMO Blue Shield plans are way less expensive. Here is another piece of advise, if you can trade off the benefits
of a PPO plan and get the Trio HMO instead, you will save yourself lots of big
bucks every month. Feel free to reach me directly and I’ll give an exact
comparison of these two plans. Since the monthly premiums are very individual
and depend on factors like age and zip code, I can’t give specifics in this
video, but I will be glad to provide a personalized quote and comparison at no
extra cost to you.
So, as you know the
health insurance plans are classified as one of four levels of coverage: Bronze,
Silver, Gold or Platinum. In addition to those four levels of coverage, a
minimum coverage plan is available to those who are younger than 30 or can
provide certification that they are without affordable coverage or are
experiencing hardship.
The bronze plans have
lower premiums, but higher out of pocket costs. The platinum plans have higher
premiums, but you pay less out of your pocket when you see the doctor. Let’s
look in detail at all these plans and make sure to watch the video until the end,
as i will give away free tips and helpful advise on selecting a health plan for
your and your family and save money!
Let’s take a detailed
look at health plans offered by Blue Shield. We will go over in detail and see
what are the co-pays, deductibles and other out-of-pocket costs, etc. so there
are no surprises when you use the plan.
We will start with the
basics:
Preventative Care:
- Under the Affordable Care Act (ACA) consumers are eligible to receive certain preventive health care services, based upon age, gender and other factors without cost sharing, (100% without charging a co-payment, co-insurance or deductible), as long as you obtain the services from a health plan network provider. This is true even for the bronze plans So, as you can see, the preventative visit shows 0 for all level plans.
|
|
BRONZE
60
|
SILVER
70
|
GOLD
80
|
PLATINUM
90
|
|
|
|
|
|
|
|
Individual
Deductible/Family deductible
|
$6300/individual
$12,600/family |
$2,500 individual
$5,000/family |
no deductible
|
no deductible
|
|
Pharmacy
Deductible
|
$500
/individual
$1000/family |
$130
/individual
$260/family |
no
deductible
|
no
deductible
|
|
Preventative
Care Copay
|
No
cost
|
No
cost
|
No
cost
|
No
cost
|
|
Primary
Care Visit Copay
|
$75*
(first 3 visits)
|
$35
|
$25
|
$15
|
|
Specialty
Care Visit Copay
|
$105
(first 3 visits)
|
$75
|
$55
|
$30
|
|
Urgent
Care Visit Copay
|
$75
(first 3 visits)
|
$35
|
$25
|
$15
|
|
Emergency
Room Facility
|
Full
cost until out-of pocket max. is met
|
$350
|
$325
|
$150
|
|
Laboratory
Tests
|
$40
|
$35
|
$35
|
$15
|
|
X-Ray
and Diagnostics
|
Full
cost until out-of pocket max. is met
|
$75
|
$55
|
$30
|
|
Prescription
Brand Drugs
|
$55
|
$15
|
$55
|
$15
|
|
Non-preferred
brand
|
$75
|
$25
|
$75
|
$25
|
|
Specialty
drugs
|
20%
|
10%
|
20%
|
10%
|
|
Lab
Testing Copay
|
$35
|
$20
|
$35
|
$20
|
|
X-Ray
Copay
|
$55
|
$40
|
$55
|
$40
|
|
Emergency
Room Copay
|
$325
|
$150
|
$325
|
$150
|
|
Hospital
stay
|
20%
|
10%
|
20%
|
10%
|
|
Acupuncture
|
$30
|
$15
|
$30
|
$15
|
|
Annual
Maximum out of pocket
|
$7,000/individual
$14,000/family |
$4000
individual /$8,000 family
|
$6750
individual/$13500 family
|
$4000
individual /$8,000 family
|
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