What Is California Health Insurance?

California health insurance is a plan that could help individuals, couples, and families pay for their medical expenses — even though it is purchased as social insurance, social welfare program, and privately purchased insurance. Health insurance is a term to describe insurance that protects against costs of medical services — such as medications, surgeries, and other more medical services. Health insurance can be provided by private insurance carriers and social welfare insurance programs such as Medicaid and Children’s Health Insurance — on which these insurances can both assist individuals who are financially incapacitated to afford medical expenses.

In addition to health insurance as financial protection for medical services — health insurance can also refer to insurance that can cover prolonged-term nursing, disability, and custodial care needs.

Health insurance

How Does Health Care Insurance Works?

Health insurance could provide coverage that varies widely, depending on its insurance provider. Besides, health insurance offers different amounts of financial protection. Health insurance can be difficult to operate — because an individual is required to choose where he wants to purchase his insurance. Besides, if the patients choose a care provider that is beyond the designated hospitals of the insurer, the insured will be obliged to pay 40% more of the costs of its insurance premium. However, in some cases, the insurance company even refuses to pay the services — that are acquired outside their designated health care providers. Besides, nowadays, it isn’t very easy for an individual to find health insurance that is affordable and has an affordable price. Here at California Health Insurance, we can help you find health insurance from A-rated insurance providers. Get a free quote here.

Health Care Insurance Enrollment

Private Health coverage can be purchased on a group basis, or by individual consumers. Usually, most Americans who receive private healthcare insurance are through their employers. However, Under the Affordable Care Act — employees who work as part-timers or employees who only work for less than 30 hours a week — are less likely to be offered health insurance coverage by their employees.

The business itself pays this type of insurance on behalf of its employees — sometimes as a part of its employee’s benefits. The employer typically pays a substantial amount for the insurance. Usually, most employers pay, 85% on the premium of their employees and a minimum of 75% for the premium of its dependents. Additionally, the differences will be paid by the employee on tax-free basis earnings. However, often these employees who receive employer-sponsored health insurance tend to have lower cash wages.

Public Health programs provide coverage for most seniors and low-income individuals and families — to whom are qualified on eligibility requirements. The most usual public programs are;

Medicare is a federal program for seniors who are above 65 years old — and become disabled totally and permanently. Besides, it also covers seniors who are at the end stage of renal disease and elders with Amyotrophic Lateral Sclerosis.

Medicaid is a social welfare program that provides health care coverage to all eligible low-income individuals — including children, adults, pregnant women, and people with disabilities. Coverage will only be applicable if the individual meets the eligibility requirements.

This health insurance program covers the children of the family who are not eligible for the Medicaid program — because their family earns much money to qualify for the program, but could not afford to buy private health insurance.

Military health benefits provide benefits for retired service members, active duty military service members, and its dependents. Usually, benefits for militaries are from the Department Of Defense Military Health System or MHS. Besides, military veterans may also be eligible for the benefits of the Veterans Health Administration.

Obligations Of The Insured Individual

1. Premium

Premium is the amount the insured must pay for his purchased health coverage. In healthcare law, premiums are determined by the use of five factors — including the age of the insured, individual and family enrollment, and tobaccos use, location, and the plan the insured chooses. Besides, under the Affordable Care Act Law, the government is obliged to cover a specific amount of the premium of an individual who buys their insurance at a private provider through an insurance marketplace.

2. Limits

Health insurance policies have a specific dollar amount limits — so for better understanding, you must ask your insurance provider about your coverage limits. So you will not end up expecting that your insurance provider will pay all the total costs of your hospital bills. Also, health insurance has an annual and lifetime maximum coverage scheme — on which the insurance provider will stop paying the insured if they reach its maximum limits.

3. In-Network Provider

In-Network providers are the health care providers that are on the list of the insurance companies — on whom agrees to treat all the insured members of the insurance provider.

Usually, this in-network provider that has a contract with the insurance provider — and usually accepts discounted rates.

4. Formulary

A formulary is the list of drug prescriptions that the insurance company will only cover for payment.

5. Deductible

The deductible rate is the amount; the insured needs to pay out of his pocket before the health insurance kicks in. For further illustration, suppose that the insured chooses a $600 deductible rate — and the insured visits a doctor for a prescription. The insurance company will only start to pay if the insured reaches its deductible rate. Furthermore, almost all health insurance policies do not apply co-pays on your deductible if it is just a doctor’s visit for a prescription.

6. Coinsurance

Coinsurance is a percentage of the total cost of the health care service the insured has to pay. For further illustration, the insured has to pay 10% of the total cost of the surgery, while the insurance provider has to pay for the other 90%. For the insured, this is a great deal — because they may end up owing a little depending on the total costs of the health care service they obtain.

7. Co-Payment

Co-payment is an amount the insured has to pay before the insurance company starts to pay for the service. Typically this co-pay applies on a particular visit to a doctor or to obtain a prescription. The difference between the co-payment and deductible is that — co-payment is usually just less than $50 — and the deductible is of a large amount of more than $500.

8. Capitation

Capitation is the amount the insurance provider will have to pay to the hospital or health care provider — who treat the insured.