Dear Tom and Alan:
I’m trying to advise some people close to me about getting health insurance.
I’ve convinced them how important it is but I’m not sure what to tell them about which (insurance) is best.
They are husband and wife with a three year-old.
The husband has a job and says he could talk to the boss about starting a small group.
Could they be eligible for a subsidy from Covered California?
If not, is it better to go directly to the insurance company for coverage?
He is 39, she is 28. They seem to be leaning toward Kaiser even though we don’t have one nearby in Calistoga.
Tom: This is a very timely question, Hal, since the open enrollment for Covered California just ended on Jan. 15.
The only way they could sign up would be if there was a qualifying event.
Some of these are: marriage, divorce, moving, losing group coverage, and, the favorite here at Schrette Insurance: getting out of jail.
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Anyway, we’ll have to discuss this further with you and get more information.
Al: Not everyone realizes that open enrollment is also closed now for those who want to apply directly to the insurance company.
We often hear, “But wait, I’m in perfect health! You mean I can’t get anything?”
Since the main reason to go to Covered California is to receive a government subsidy to pay the monthly premium, the main questions are: ZIP code, number in household and total household income.
Tom: On the other hand, an employer group plan can start up just about any time.
One thing all plans have in common is the “metal tier” concept. Whether group or individual, in or out of Covered California, plans are Bronze, Silver, Gold or Platinum.
So, I went to the Kaiser Broker Portal and ran a quote for a small group.
Here are the results for the family, ages 39, 28 and 3:
- The least expensive Bronze plan is $288.75, $248.71 and $189.02 (that’s for husband, wife and child respectively)
- The least expensive Silver plan is $339.28, $292.23 and $219.65
- The least expensive Gold plan is $402.32, $346.53 and $257.87
- The least expensive Platinum plan is $504.40, $434.46 and $319.75
Al: The reason it’s important to know the rate for each individual in the family is that very often the employer will pay a percentage of the employee cost. Or, the employer may pay 100 percent of the employee and zero of the dependents.
So if the employer chose the Bronze plan for the group, he/she would know that each month there would be a bill coming from Kaiser for $726.48. Whatever is on the employer application is what the company is responsible for.
In the case of the Platinum plan, the company would receive a monthly bill for $1,258.61. In the 100 percent scenario, the company would pay $504.40 for the employee and payroll deduct a total of $754.21 for the two dependents.