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What Kind of Health Insurance Plan Designs are Available Through California’s Exchange?


California officials recently shared some of the design plans behind the state’s health insurance exchange (known as Covered California), from which individuals and families will be able to purchase their coverage in 2014. The goal of the health insurance exchange is to provide as many Californians coverage options as possible, all in a marketplace where each individual or family can select the plan that is best for them.

Federal Model

The federal healthcare reform law laid out the breakdown of the different policy types as platinum, gold, silver and bronze. The difference between the various levels regard the out of pocket expenses that the insured will have to pay for treatment and medical procedures. For example, a platinum plan would limit insured payments to approximately 10% of the cost, whereas the bronze plan would make the patient responsible for about 40%.

From Federal to State

Although the federal model requires that certain services must be covered by the carrier (like prenatal care or prescriptions), California is making the services covered much more clear on the state level. Officials felt that the biggest challenge with current healthcare is that consumers were unable to navigate their own policies due to confusion over what services were covered or not. The California model goes one step further and breaks down exact co-pays and patient responsibilities for greater transparency for the policyholder. On February 13, 2013, California Health Exchange has finalized the individual plan design.

Coverage Examples

Due to support from federal subsidies, many California families would experience the cost benefits of being lower or middle income. For example, a family of four with income under $35,000 would pay about $120 a month for coverage and the same family making $47,000 would pay approximately $247 per month.

There are differences in deductibles, too. The “silver” plan offers a $2,000 annual deductible alongside a $45 office co-pay for general visits. The platinum plan is more expensive and thus requires no deductible and a cheaper co-pay ($25). (Source: Los Angeles Times, Details of California’s healthcare plans, February 13 2013).

Bottom Line

Ultimately, consumers will be able to choose the plan that best fits their needs. Those who don’t visit the doctor much may prefer a less expensive plan with a higher deductible, and those with more frequent needs might prefer a more expensive plan with cheaper co-pays and no deductible. Consumers will benefit from the many available plan designs.

*Quotes listed above are samples and are not guaranteed. Quotes are subject to change at any time without notice.*