Individuals And Families Into Health Plans

Individual/Family Health Insurance

Serra Benefits has been fitting individuals and families into health plans for over 20 years. Our goal is to find the policy that gives you the best benefits for your insurance dollar based on your unique personal needs. We are appointed with all major health insurance carriers and offer health, dental, and vision insurance.

Call us today to review your options!
760-439-9700

We are licensed agents and Covered California certified

With the individual health insurance market experiencing historical changes as a result of the PPACA (Patient Protection and Affordable Care Act) initiated in 2010, Serra Benefits has held steadfast through these changing times. We are certified with Covered California, our states healthcare exchange, which makes us even better able to evaluate your circumstances and help you make an educated and informed decision on the best policy. We can answer all of your healthcare questions and keep you up to date when the market changes again.

Types of Health Insurance

  • HMO – Health maintenance organization – Typically smaller network/Managed Care
  • PPO – Preferred provider organization – Larger network/Most freedom
  • EPO – Exclusive provider organization – Cross breed of HMO and PPO 
  • HDHP – High-deductible health plan – Health plan that is compatible touse with an HSA account (health savings account)

Difference between HMO and PPO plans

HMO and PPO are two of the most popular types of major medical health insurance plans. The major differences between HMO vs PPO plans can be found in the:

  • Size of the network
  • The cost of the plan
  • The ability to see specialists without referrals
  • The size of the in-network
  • The coverage for out-of-network services

The big difference between HMO and PPO policies for many individuals and families, is the primary care doctor. With an HMO, you will have a primary care doctor whom you go through for most medical services. Specialist visits and other services are done by referral within the medical group by your primary care doctor. Often times HMO plans have lower premiums due to this managed care system and lower contracted rates with the doctors.

If having a primary care physician (PCP) give you referrals is not desirable and you want the freedom to go to any specialist in or out of network without referral – a PPO is best for you. Some are comfortable with managed care, more predictable out of pocket costs, and often lower overall premiums of an HMO, while others enjoy or need more overall freedom to choose and a larger doctor network. Deciding between an HMO vs PPO is very specific to each family or individual’s needs. Serra Benefits will make this easy and find the best fit for you.

Call us today at 760-439-9700 to enroll!

Covered California (On-Exchange) or Direct (Off-Exchange) – Which One?

Great question! It really comes down to whether you income qualify for tax credits or not. Eligibility is  based on your household adjusted gross income, the number of people in your taxable household, age, and location. We can quickly determine your eligibility to decide which path is best for you. We are a Covered CA Storefront and can enroll via phone state-wide both on and off exchange. We also work with a very large self-employed population.

Healthcare News

  • California legislation passed AB 414. It requires ALL California residents to purchase health insurance for themselves and their dependents to maintain minimum essential covereage (MEC). California is one of several states that are actively pursuing, or have already adopted, their own state wide individual mandates.
  • The new individual mandate for Californians starts in 2020. The penalty for not having insurance will mirror the one under the Affordable Care Act, which was $695 per adult (and $347.50 per child under 18) or 2.5% of annual household income, whichever is greater. That can amount to thousands of dollars a year
  • California Gov. Gavin Newsom’s new state budget has infused significant funds (eff 2020) to make health care coverage sold through its health insurance marketplace (Covered California) more affordable and has made new subsidies available to middle-income individuals earning between 400% – 600% of the federal poverty level (FPL).
  • Advance Premium Tax Credit (APTC) If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you’ll have to pay back the excess when you file your federal tax return. If you’ve taken less than you qualify for, you’ll get the difference back.
  • How does the tax credit (subsidy) work? The IRS pays your premium tax credit directly to your health insurance plan. Your monthly premium costs are lower as a result. … The only way to get premium tax credits is to buy from Covered California. If you bought from Covered California, it will send you a tax form, called the Form 1095-‐A at the end of each year to submit when you file your federal income tax return on or before the due date.

Open Enrollment Period (OEP)

The period of time annually when anyone may apply for health insurance, change carriers, or change level of coverage on or off exchange without a qualifying life event.

Enroll November 1-December 15 = January 1 Effective Date

Enroll December 16- January 31 = February 1 Effective Date

Extentions (if any) are NOT guaranteed and undetermined

Special Enrollment Period (SEP) – Proof Required!

Consumers who experience a qualifying life event any time in the year may enroll on or off exchange within 60 days of the life event. This is a called special enrollment period. 

List of qualifying life events:

  • Losing health coverage. For example: consumers who no longer qualify for Medi-Cal, or who lose health coverage through their job or spouse’s job.
  • Income changes so much that a current Covered California enrollee becomes newly eligible or ineligible for help paying for their insurance.
  • Turning 26 years old and no longer being eligible to stay on a parent’s plan.
  • Moving to from another state or within state to an area where a current client no longer has access to their plan. 
  • Having a child or adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.
  • Getting married or entering into a domestic partnership.

Due Dates to Enroll after a Qualifying Life Event

Consumers have 60 days to enroll on or off exchange from the date of their qualifying life event.  If 60 days pass and consumers have not signed up for health coverage, they will have to wait until the next open-enrollment period and will be subjected to the individual mandate penalty.

 

Carriers

Contact us

If you have any questions on polices or have additional questions before get a free quote, please contact our offices today.

2821 Oceanside Blvd. Unit E
Oceanside, CA 92054

Phone: 760-439-9700
Email: jyoung@serrabenefits.com or angela@serrabenefits.com

CA License Number: 0C17508

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