California Individual Health Insurance Quote Information

Which plan should I choose?
How do insurance companies price plans?
Can insurance companies decline my application for coverage?
What can I do if I’ve been declined?

Which plan should I choose?

Sometimes too much information can be overwhelming. To help you sort through it, consider these ideas:

If you have a doctor you like and trust and he or she is a primary care doctor, you may want to enroll in an HMO plan. You’ll pay very little when you need medical care.
If you prefer the freedom to choose any doctor when you are sick or injured, you may want a PPO plan.

Compare health plan BENEFITS by looking at:

Doctor’s Office Visit cost ($10 – 40$)
Hospital admission cost (per day or per admission)
Prescription medicine cost (generic, brand, “non-formulary” allowed)
Maximum Out-Of-Pocket (OPP) amount (usually this is the most you’ll pay in a calendar year if you get really sick. After the OOP maximum the insurance usually pays 100% of allowed medical costs.)

Compare health plan COSTS by looking at:

Monthly Premium (multiply by 12 to calculate annual premium cost)
Annual Deductible (add to the annual premium to determine annual cost)
Maximum Out-Of-Pocket (determine the most you’d pay if catastrophe struck)
There is an inverse relationship between benefits and costs: the higher monthly premium you pay to the insurance company, the less you pay when you obtain medical care.

Figure out how much you can afford to pay monthly versus the amount you’d pay if a catastrophe struck. Insurance should keep you from financial ruin.

>> top of page

How do insurance companies price individual health insurance plans?

There are many criteria the insurance companies use to determine the price of an individual health plan: the age and health status of the proposed insured, the county in which the person lives, and, the benefits desired. So, if you are young and healthy it’s less expensive than if you are older and have pre-existing health problems. It makes sense: the latter group will likely seek more medical attention than the former.

Also, in terms of the benefits, the more the insurance company pays when you get sick, the more expensive the health plan. For example, a no-deductible PPO plan that pays 90 percent until a “stop-loss” or “out-of-pocket maximum” of $1,500 will cost significantly more on a monthly basis than a PPO plan with a $2,250 deductible. In the latter case, the insurance company only pays after a patient has paid $2,250 per calendar year in medical care. This type of plan will cost less on a monthly basis than if there were no deductible. So, you can pay a low monthly premium to the health insurance company and pay a lot of money to the doctor or hospital when you need medical care. Or, you can pay a high monthly premium to the insurance company and pay a little amount of money to the doctors and hospital when you need care. There is a trade off. You must find the balance that works well for you.

>> top of page

Can insurance companies decline my application for individual coverage?

Yes. If you have pre-existing medical conditions insurance companies can decline to offer you health insurance. The companies views someone with a pre-existing medical condition seeking health insurance as an auto insurance company views someone seeking insurance auto accident insurance, after they’ve already crashed their car. Clearly, applying for coverage after you need is too late. You must purchase health insurance while you are healthy. The insurance companies have “underwriters” who decide to offer coverage or not on a case-by-case basis. The insurance company’s criteria differ, so you may want to apply to more than one insurance company.

>> top of page

What can I do if an insurance company has declined my application?

You can appeal a decision by speaking with the insurance company. Sometimes you can speak directly with the underwriter. Also, the insurance company will usually tell you why they declined to offer you health insurance. Sometimes the medical information they have is inaccurate. You can ask your doctor to correct the mis-information, if that is the situation. Also, you can apply to another company.

If you are unable to obtain a personal health insurance policy, you still may have other options. Some people can continue their insurance under a past employer through COBRA or Cal-COBRA. You have a specific time to apply for this coverage, so make sure you don’t loose that option. People who have completed 18 months of COBRA coverage may also be eligible for HIPAA guarantee issue plans. The experts at can assist you with enrolling in a HIPAA guarantee issue policy. Finally, if you are unable to obtain any coverage through these means you may be eligible for the State of California’s Major Risk Medical Insurance Program.

>> top of page