So you want to know how to get the best individual health insurance plans in California but you're not sure where to start or even what to look for.
Really the first place to start when shopping for individual health insurance plans in California is to determine what fits your needs the best, is it a PPO (Preferred Provider Organization) an HMO (Health Maintenance Organization) or an HSA (Health Savings Account).
Different individual health insurance plans in California and their explanations
A PPO is a group of physicians that have agreed to a certain rate of reimbursement for each service they provide. So each physician has agreed to a $120 charge for a regular office visit (for example). The insurance will cover either a certain percentage of this, usually 80% for a participating provider, or some even will cover the whole thing subject to a copy, say for instance $20. The advantage to a PPO is that you can choose to go to any physician in the PPO and get this same rate. You do not need a PCP (Primary Care Physician) and there are no "referrals" required by the insurance company in order to have your visit covered. The disadvantage is that PPO coverage is usually more expensive than any other option.
An HMO is a group of physicians that have agreed to a certain rate of reimbursement for each patient they provide services for. So, as an example, being a PCP (Primary Care Physician) would pay that physician a certain amount per month to care for his patients as opposed to being paid for what they actually do for that patient. All HMO's cover the entire cost of your medical care subject to a copay of between $5 and $100 depending on the service being provided. The advantage to a HMO is that the coverage is the least expensive of all the options. The disadvantage is that you must see your PCP and get a referral to a specialists if your PCP determines that it is necessary.
An HSA is actually a savings plan coupled with a PPO. You have a high deductible (at least $1,150 in California) that you must satisfy before the plan actually starts paying any benefits, but you can take this money out of your paycheck pre-tax and you have some control over how your money is invested and used. The biggest advantage of an HSA is that you get the low cost of an HMO coupled with the flexibility of a PPO. The disadvantage is that you have to satisfy that high deductible before the plan starts paying benefits.
