July 16, 2024

Measured By The Heart

All About Healthy Life Style

Understanding and Comparing Health Insurance in California

With all the health insurance options that are available it might be overwhelming with choosing the right health coverage. Every state offers different health insurance options based on the laws in that state. California residents have one of the largest selections of health coverage that is available today. This guide will help you understand eighty percent of all the health insurance options that are available to you in the state of California.

When comparing health insurance plans there are three main categories that you will be looking at. Three categories are; office consultation, prescriptions drug coverage and everything else that is build in to the deductible.

1. Office consultation. With most health insurance plans, you will have a copay or co-insurance to pay for office consultations. The copay or co-insurance are typically not subject to the main deductible of the plan. A copay is a fixed amount such as $30 for an office visit. Co-insurance is a fixed percentage such as 30% for an office visit. An example of co-insurance would be:

Office Visit: $100 charge

Negotiated rate: $ 60 charge

Co-insurance: 30%

In this case, the subscriber would pay 30% of the negotiated rate of $60 for a total of $18. The negotiated rate is the charge that an in-network doctor or provider has agreed to in order to participate in that network. This usually applies to PPO type plans.

The office copay or co-insurance is only for the consultation itself. If the doctor runs labs, performs procedures, or does other services in addition to the consultation, these charges are handled in the third section and will be in addition to the copay or co-insurance.