Frequently Asked Questions
How do I get a Kaiser Permanente Quote?
to obtain an instant
How do I pick the right plan for me?
Take a look at our Recommended Plans
via the navigation menu above for the plans we suggest for people in all types of situations. The two main things to consider when choosing a plan are:
- Do you prefer to pay more to the Insurance company OR your Doctor?
The general rule is the more you pay for insurance, the less you will pay the doctor and vice versa.
- Which Insurance Companies is your Doctor(s) "Contracted" with?
You should only consider plans from Insurance companies that your Doctor(s) are "Contracted" with (aka IN-Network Provider). Otherwise, your Doctor will be considered an Out-Of-Network Provider and will end up costing you significantly more. So we highly recommend confirming that your doctor(s) are "Contracted" with the plan you are considering before you apply. This can be easily done by either:
- Searching for your doctor(s) on the insurance companies website via our
Find an IN-Network Provider page.
- Calling your Doctor(s) and asking if they are a "Contracted/IN-Network" provider of the plan you are considering. DO NOT ask if they "take or accept Insurance" because 99% of doctor's will answer "Yes" based on the fact they will accept payment from any insurance company. However, just because they will accept payments does NOT mean they will charge you the Contracted/IN-Network rates of that insurance company. Thus, leaving you responsible for the difference, which can be substantial depending on the services rendered.
What is the difference between a PPO an HMO plan?
The simple answer is Freedom to choose any provider you like. PPO plans give you the freedom to visit any Medical Provider of your choice. HMO plans require that you get a referral from your primary care physician before visiting any other provider. For example, let's say you broke your nose playing basketball. Under a PPO plan, you can make an immediate appointment with an Ear Nose and Throat specialist. Under an HMO plan, you will have to see your primary care physician first and he or she will refer you to a Ear Nose and Throat doctor if they determine you need to see a specialist.
Under both plans structures, you still need to pay special attention to whether or not the medical provider you choose is a Contracted/IN-Network provider with your insurance. Otherwise, it will cost you significantly more to see that out-of-network provider. PPO plans will pay a lesser % for any out-of-network providers you use and HMO plans will pay NOTHING
You might be wondering, why would anyone choose an HMO Plan? The main reasons are that the deductibles, co-pays and out-of-pocket maximums are typically much lower than PPO plans. This means HMO plans are usually much richer in terms of benefits than PPO plans. For example, a typical HMO plan may have a $20 office visit co-pay with $500 deductible versus a typical PPO plan will have a $40 copay with a $2,000 deductible. As you can see, there is a price in terms of benefits for the Freedom you are allowed under a PPO plan.
How do I find a Primary Care Physician (PCP) if I have PPO plan?
As of January 1, 2017, your health insurance plan will select a Primary Care Physician for you based on the physician you have been seeing. If you are new to a plan, a PCP that is located near where you live will be assigned within 60 days of your effective date. Once your Primary Care Physician is selected, you will be able to change to another physician at any time you choose. Rest assured that having a Primary Care Physician does not change your PPO, but is an added feature. You may still access any provider, inside or outside the network, and do NOT need a referral to access specialists.
PPO's are often the best choice if you want full access to a wide range of providers WITHOUT consent from a Primary Care Physician, but finding the right provider can be difficult and confusing. Your Primary Care Physician will be an advocate for you, helping you to navigate the health system when you need assistance selecting the proper specialist, coordinating your care with other providers or ensuring you understand your treatment options. While having a Primary Care Physician is important, you can choose to navigate the health care system on your own and you do not need permission from your Primary Care Physician to seek treatment. Research shows that having a relationship with a Primary Care Physician is important to your overall health and well-being. Having a Primary Care Physician means you will have someone you can turn to for health care advice —whether it’s preventive care, treating common illnesses and injuries, or recommending a specialist when you need one.
Why would I want an HSA medical plan?
We love HSA (Health Savings Account) medical plans at Cover Health CA! Here are the reasons why:
- HSA medical plans give you the ability to pay for qualified medical expenses with pre-tax dollars (meaning income-tax free!) AND save for your retirement on a tax-deferred basis, just like an IRA.
- HSA Accounts can be setup at almost any financial institution once you have an HSA medical plan from an insurance company.
- Like an IRA, the account belongs to YOU. This means you will never lose the money unless you spend it all!
- You can use HSA money for almost any medical expense, except for paying your Health Insurance premiums.
- HSA medical plans typically have a lower premiums because they have higher deductibles.
HSA medical plans are right for you people who:
- Prefer to pay more to the Doctor when you actually NEED medical attention instead of paying more to the insurance company every month.
- Like to save money and would actually contribute to their HSA account. The fundamental idea behind an HSA medical plan is to take the $ you save by having lower Health Insurance premiums and put it into an HSA account for when you need Medical Care. So if you are not a good saver or simply can't afford to save anything right now, we would not recommend an HSA medical plan for you.
- Have a ROTH IRA and already maxing it out. An HSA medical plan will give you another vehicle to save money on a tax-free basis. Interest earned in an HSA account is not considered taxable income when the funds are used for eligible medical expenses. At age 65 or older, there is no penalty to withdraw funds from an HSA account for any reason. However, normal income taxes will apply for distributions not used for medical expenses.
If you are sold on an HSA plan, get a quote and apply now by clicking here
. You can also apply for our favorite HSA medical plan via our Recommended Plans
page, which can also be easily accessed on the navigation menu above.
If you have more questions on HSA plans, click here
for a great resource on HSAs. For more information on opening an HSA account, we recommend HSA BANK
IN-Network Provider vs. OUT-of-Network Provider?
It is best to ALWAYS use IN-Network Providers when possible. WHY you ask? The costs can be double or triple if you use OUT-of-Network providers. This is why we HIGHLY recommend confirming your doctor, hospital, urgent care, pharmacy, or any other medical service provider is actually an IN-Network provider before you get services rendered.
IN-Network providers are contracted with your Insurance company, which means the rates for all services have been pre-negotiated, thus lowering your costs overall. This is actually one of the major benefits to having medical insurance. Your insurance company has already negotiated the lowest rates possible on your behalf because it's in their best interest to keep your coinsurance responsibility as low as possible because then it will take you longer to reach your annual out-of-pocket maximum. After reaching your out-of-pocket maximum, you will be 100% covered for all approved medical services rendered. Needless to say, Insurance companies do not want you reaching your out-of-pocket maximum and lowering your costs for services rendered is the only way to accomplish this.
OUT-of-Network providers are simply not contracted with your insurance company. This means they can charge you whatever they want for the services rendered. For example, a doctor's visit with an IN-Network provider may only be a $30 copay for you. However, that same doctor's visit with an OUT-of-Network provider may cost you $200. WHY? The OUT-of -Network will typically bill you directly rather than billing your insurance. So let's say this OUT-of-Network doctor charged you $270 for the office visit. You will have to pay that in full and than submit this claim to your insurance and they will only reimburse you what they would have paid an IN-Network provider for that same service, which may only be $70. Therefore, the visit will end up costing you $200!
Why are some doctors considered Out-of-Network providers?
Doctors and insurance companies continually fight over what the reimbursements/payments should be for services rendered. Insurance companies always want to keep the reimbursements as low as possible and doctors obviously want the opposite. In some cases, the Doctor and insurance company can not agree and the doctor chooses not
to accept the insurance company's reimbursement rates. Therefore, this doctor would be considered an Out-of-Network provider for that insurance company.
Many doctors are gravitating towards being an Out-of-Network providers because they can charge more for their services. For Example, Dentists are typically the most well paid doctors because they typically do not accept contracted rates from insurance companies for any major services. Therefore, many other doctors have started to follow suit because they believe all insurance companies are reducing their reimbursements to a unfair level that will not allow them to sustain their practices. Unfortunately, only the consumer (you) is hurt by this everlasting battle between doctors and insurance companies because you will be responsible for difference between what the doctor wants and your insurance company actually pays when you use an Out-of-Network Doctor.
How does the Deductible, Co-pay, Coinsurance & Out-of-Pocket Maximum affect me?
Why didn't I see the plan I was looking for when I did a quote via the website?
Here at Cover Health California we like to only show plans we believe are generally the best on the market to make the decision easier and less complicated for the user. However, we do represent all the plans from all the major carriers, so if there is a specific plan or deductible range you want to see more options for, please email us at firstname.lastname@example.org what you are looking for below and we will send you a personalized quote within 24 hours or less.
Frequently Asked Questions for Dental
How do I get a Dental Insurance Quote?
Dental Insurance can be easily added on to any Medical plan when applying for coverage. You will see the various options available during the online application process. The prices range from $17-$62 a month depending on if you select a PPO or HMO plan. If you are looking to purchase Dental coverage ONLY, please visit our
in order to obtain instant quotes and apply online.
How does Dental Insurance work?
Dental insurance works in much the same way that medical insurance works. For a specific monthly rate, you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia. PPO plans usually have maximum benefit amount ranging from $1K - $2K annually and are typically more expensive. HMO plans usually have unlimited benefit amount and are lower in price, but the network of participating providers is much smaller. So if you are already have a Dentist, we suggest asking your Dentist's office what type of insurance they are "contracted with" before applying for coverage.
How do I find a Good Dentist?
We suggest doing the following to find a good Dentist in your area:
- Get a list of IN-Network Dentists for your Insurance Plan. If you don't have a list of IN-Network providers, use our Find an IN-Network Provider tool.
- Search for reviews of the Dentists in your area on Yelp.com
- If you have or Applying for an HMO Dental Plan, make sure to take note of the Dental Office number because you will need that number when you apply.