How to compare and buy health insurance in 2019. What are the Benefit Pland Designs and Medical Cost Shares?


Compare Various Health Plans for 2019 

If you are shopping for health insurance for year 2019, this presentation will help you see side by side comparison of various health plans and possibly help you decide what plan would work best for you and your family. 


The information presented here applies for  health plans available in California for both private and exchange plans.

Now, remember if you are getting your health insurance through the exchanges you can still get tax credits or subsidies as well as enhanced plans for the year 2019.  By the way, if you are confused about the ACA law changes or have no idea what your options, feel free to reach out to me directly - www.InsuranceCenterHelpline.com I am a  Licensed Insurance Agent in California and have contracts with all major carriers in the state, so I have access to the information, rates and so on and will be glad to help!

For year 2019, in terms of the plan design not much has changed.

We still have 4 main categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care. There is also a catastrophic plan for those that qualify (usually for those who are under the age of 30). 




 Each level pays a different portion of your health care bills. Grouping plans this way makes it easier to shop for insurance. For example, the top-of-the-line plan is “Platinum.” It pays the highest portion of your health care bills It also costs the most. The basic plan is “Bronze.” It pays on average 60% of your health care bills and costs the least.



The Catastrophic plan or a minimum coverage plan-  is for those who are under the age of 30. Quite frankly, this plan is a bit tricky… so if you are considering it, I highly advise that you study the benefits carefully before applying for this one. Again, this is an option only for those under the age of 30.  

Now,  There is one very important thing that many consumers do not know, and end up overpaying for their health insurance. Those who have minimum coverage plans do not qualify to receive premium assistance (also known as Advanced Premium Tax Credits). 


  • Minimum coverage plans usually cover three doctor visits or urgent care visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until you reach the out of pocket maximum



Now, let’s talk about the bronze plans:

  • These are usually the high deductible plans. On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent. I will go over the details for this plan shortly
  • Silver: Plans are a good alternative for those that can’t tolerate a high deductible plan, yet, don’t want to overpay for a higher level coverage. As I mentioned in the begging of this presentation, In some cases, individuals may qualify for an Enhanced Silver plan. This means that when they choose a Silver plan, they have  - based on their income– enhanced out-of-pocket savings through lower copays, coinsurance and deductibles. Individuals in these savings categories get the benefits of a Gold or Platinum plan for the price of a Silver plan. These plans are only available on the exchanges! Feel free to reach me and I’ll help you understand if you qualify for enhanced silver plans.
  • Gold: Plans do not have a deductible and the premium is a bit higher. On average, your health plan pays 80 percent of your medical expenses, and you pay 20 percent.

·         Platinum: Is the highest level of coverage. It pays on average 90% of the medical expenses and does not have a deductible.







And, now let’s take a look at a comparison of plans for year 2019: As I said, this is a general plan design, so no matter what health plan you select – BlueShield, Kaiser, Oscar, Valley Health Plan, HealthNet, Anthem BlueCross, Sutter Health and so on… you will be looking at the same plan structure if you are comparing “apples to apples”

Here are the metal categories and coverage for year 2019.

Now, before I go into the plan details I wanted to mention that in case any of the terminology is unclear, please feel free to watch my videos where I explain what is a deductible, what is a copay, what is a coinsurance and so on. This will help you navigate the benefits structure of the plans and get an idea of how these plans works.

Let’s take a closer look at these plans:

For bronze plans- you don’t pay the deductible for the first 3 visits per year (which includes a combination of primary care, specialist and urgent care). The lab is $40 and is not subject to deductible. The Annual Wellness Exam (preventative) is included at no extra cost. The copay for the primary care visit and urgent care is $75 and specialist visit is $105. This might be a good plan for those that are healthy and rarely go to the doctor. Obviously, if you need more care, you will have to pay more out of pocket.


Now, Let’s look at the Silver plan

-          The silver plan has a lower deductible. There are no restrictions on how many times you can visit the doctor. You will pay deductible mostly when you are hospitalized. Here are the copays for this plan:

Deductible: $2,500
Primary Care Visit & Urgent Care: $40
Laboratory Tests: $35



The gold plan has no deductible. The copays and coinsurance are lower than those for the silver plan. This plan costs more each month, but the insurance pays on average 80% of your medical cost and you pay the rest.

Deductible: $0
Primary Care Visit & Urgent Care: $30
Laboratory Tests: $35



The platinum plan has no deductible. The copays and coinsurance are lower than those for the gold plan. This plan costs more each month, but the insurance pays on average 90% of your medical cost and you pay the rest. Obviously the platinum plan has the highest premium each month. If you are healthy and rarely go to the doctor, it might not be a good idea to buy the most expensive plan on the market, right?

Deductible: $0
Primary Care Visit & Urgent Care: $15
Laboratory Tests: $15



Now, You can take a look at a more detailed comparison on my web site (or at the the top of this article) . I can also provide a comparison of rates and plans. So, for example compare BlueShield with Kaiser, Oscar, HealthNet, Sutter Health, Anthem Blue Cross, VHP plans and so on. There is no extra fees for my services, so feel free to take advantage of professional help and advice! 





Please note that dental coverage is not included in the medical plan. So, if you need dental insurance, that is separate. The same applies for vision. Only pediatric dental and vision is included in the medical plans at no extra cost. Since dental plans could be a bit tricky, learn your options before buying it. You might also benefit from the negotiated rates for dental and vision plans available through CoveredCA. Again, I can help with that as well! 


As you probably know, the penalty for year 2019 was repealed. So, it’s no longer a requirement to get health insurance. Honestly, it shouldn’t have been a deciding factor whether or not you need health insurance anyways. If you don’t have health insurance you are putting yourself and your family finances at risk. Even nowadays, the main reason people file for bankruptcy is because they did not have health insurance and had to pay for medical bills 100% out of pocket. Now, even the cheapest bronze plan will pay 60% of the medical expenses and will put an annual cap on how much you pay. So, think about it… no one forces you to buy health insurance, but no one will pay your medical bills if you have them… so it’s up to you. 


The open enrollment requirement is still enforced. 

In California you can buy health insurance starting from October 15, 2018 through January 15, 2019.


 Once the open enrollment closes, you no longer can apply for health insurance unless you have a qualifying life event. You can check out our video about the specifics of the qualifying life event.  

More about the open enrollment in our video: 





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