Major Medical California health insurance

The term Major Medical is constantly interchanged with catastrophic health insurance on the California market but regardless of the name, it makes more and more sense to go this direction on the health market. Let\’s look at how Major Medical California health plans work and which ones are currently the best priced options on the market.

Major Medical brings health insurance back full circle

Major Medical California coverage generally refers to health coverage designed to cover the big medical bills that can bankrupt or seriously impact Californians financially. Health insurance in California actually started out this way with basic high deductibles that you met before coverage would start. In the 80\’s, with the advent of PPO\’s and HMO\’s, richer benefits came into play (think copays and low even no deductibles). Major Medical plans took a back seat until the rates came roaring back and then out of financial necessity, Californians started to rethink major medical options with lower monthly premiums. Let\’s look at how major medical health plans work.

It\’s all about the deductible and Out of Pocket maximum for Major Medical

There are two main ways that Major Medical health plans keep cost low. The first is the deductible. The deductible refers to an amount of money (let\’s say $3500) that you must pay first before getting help from the carrier. Keep in mind that you will still get the PPO negotiated rates when in-network and using network doctors. This can bring your true out of pocket down by 30-60% in most cases. Once you meet your deductible, you generally pay a percentage until you hit the OOP or Out of Pocket Maximum. The plan generally pays 100% of remaining calendar year covered benefits, in-network. For some HSA major medical plans, the deductible is the same number as the maximum (all-inclusive).

Let\’s look at a Major Medical plan example.

Let\’s say you have a $3500 deductible and $3500 max out of pocket (separate amount) and you get a $50K bill. You would first pay the deductible of $3500. You then start to pay 30% of the remaining charges until you hit another $3500 out of pocket for a total of $7K towards the $50K bill. Assuming in-network and covered benefits, the carrier would pay the other $43K. That\’s the whole point of major medical health plans…cover the big bill. What\’s the trade off or benefit? Premium savings. That $3500 deductible major medical plan might be a few thousand dollars cheaper than a richer plan (say a $1000 deductible). In a bad year, that savings offsets the higher deductible. In a good health year, you keep the money. That\’s why more and more people are going towards major medical plans. So which plans on the market are the best values for major medical?

Current good values for California major medical health plans

Right now on the individual family health market, we would consider the following major medical health plans when you run your quote:

Anthem Blue Cross Clear Protection $3300

Blue Shield $4000 or $6000 Savings plan

Health Net Advantage $3500 or $6500 plan

You can go with higher deductible but rarely get lower costs than these options. If you want HSA coverage (for the tax benefit) look at Shield\’s Savings. Otherwise, Health Net\’s Advantage plans have been very well priced. We\’re happy to walk how these plans compare for your specific situation. Feel free to contact us by phone or email.

Health Reform and Major Medical

One big impact from Health Reform is that certain levels of benefits will be mandated which means the available plans will likely be much richer than most California major medical plans on the market now. We should have the rates and benefits summertime of 2013 to compare.