I can’t stress how much I appreciate you making this video! I finally got approved for Medical today and tried to call them to set up a plan, and was so confused. This is super informative, and really helped give me somewhere to start
Thank you, Kevin. I received the notification you spoke of in my situation to consider Silver Enhanced. Very helpful discussion. I'm going to listen again to the liability discussion toward the end. One has less liability with a Silver Enhanced 73 than a Bronze 60? I don't think you're meaning less exposure; less cash paid out.
The maximum out-of-pocket amount is less with a Silver 73 than a Bronze 60. Once you reach the max out-of-pocket, the health plan covers all network services and prescriptions 100%. In the event so some nasty accident you will be liable for a small dollar amount of medical bills under the Silver 73 than the Bronze 60.
Thank you for this info sir and I have a question, let's say we qualify for the silver 94 due to our annual income for a family of four, but the question is we have about 100k saved, would we still qualify with that type of money in our bank account?
The enhanced Silver plans are offered based on your income, not your savings account. You could have a substantial amount of savings and still qualify for a Silver 94 plan.
Check your Covered California account and see how much larger the subsidy is beginning for May 2021. Some people are able to get a Silver 70 plan for $1.
@@KevinKnauss Thank you so much! Will do that for sure! This year, we had to change it to medical, but recently we changed our income level so that we can keep our former doctor. But Somehow, the covered California website doesn’t let me go further screen even though they are saying that we have to choose our insurance plan for June 1st. It’s a bit frustrating.
@@hotpepper4492 There could be two different issues. 1. What does the eligibility results say? If it states Medi-Cal, then the county has not released him from Medi-Cal coverage. That must happen before a plan can be selected. Or 2. When you go to select a plan, navigate to the Enrollment Dashboard and click continue shopping. If he is already enrolled, the system defaults for the dental plan selections. You need to click on the Shop for health plans title and the dark blue line under the dental plan option will switch to the health plans. Then it will ask if you want to change your plan, Yes, Continue Shopping, to choose a different health plan to begin the first of the next month.
@@KevinKnauss Thank you for your comments! I don’t know what happened, but my insurance agent helped, and he looked over my account. Finally, we could sign up for the enhanced insurance (silver plan 73) from next month. We are glad your UA-cam channel. Otherwise, we wouldn’t know which one we should get. Thank you!!
The plan designs and cost sharing seem meant to confuse people. However, you need to pick out a couple of focal points. If you see doctors or other providers on a regular basis (labs, tests, therapy, etc.) and if you take prescription medications, you are almost always better with an Enhanced Silver plan 73, 87, or 94.
Kevin Im a seasoned P&C agent. However looking for some help and mentoring with my Anthem BC BS appt. Do you have some training for sale or would you meet with me for an hourly consulting fee?
On my website, Insuremekevin.com, there is an appointment scheduler app, Calendly. Find a time that works for you and we can chat about your questions. There is never any charge for consultations other than listening to my bad jokes.
@@KevinKnauss Thats awsome! I will try booking an appointment for next week, and I appreciate you offering a consult! Looking forward to your bad jokes :)
My husband have a history of cancer and heart disease. He has operations in the past and we didn't pay anything because of medi cal. Is there a way that he can stay with Medi cal and I'll be in Covered CA if i go back to work soon?
If he is not eligible for Medi-Cal because of a disability (or over 65), then most likely he will be transition to Covered California. However, depending on how much you earn and if you have received unemployment benefits in 2021, your household may be eligible for a very large subsidy and an Enhanced Silver 94 plan. Yes, there will some costs for the health insurance and modest copays, but it is a pretty good deal.
@@KevinKnauss thank you sir! I will be starting work soon and i am scared that my income will go beyond Medi cals income limit. And yes, i am still receiving UI, but we know we can't live off that. So i am really on a hunt of a much better job.
@@lovemy2boyys If the household income is over $24,040 for a household of two adults, then you would be eligible for Medi-Cal. When you do start work, just report the increased income to Medi-Cal so they can make an eligibility determination. It is a really confusing time right now and some of the unemployment benefits won't count against you.
Thanks so much for this helpful video Kevin! I'm currently on MediCal but about to get kicked off soon. Do you happen to know if it's common for insurances to cover surgery on pre-existing injuries that occurred before enrollment? My knee accident occurred while I was on MediCal but requires surgery soon. With my insurance transitioning I'm afraid any new insurance will call it a pre-existing condition and no one will cover it. Anticipating an expensive surgery is a big factor in my decision making around which plan to choose, so was curious if you think most of the plans cover a surgery for a pre-existing condition? ...Based on what I heard you say, I'm thinking I'll probably need a Silver Plan... Thanks so much for helping to explain.
Have no worries, the surgery will be covered as long as it has been determined medically necessary, which it sounds it has been under Medi-Cal. There are continuity of care provisions within the insurance plans so procedures and treatments approved under one health plan must be covered under a new plan. It happens all the time.
My insurance at work is 200$ a month and a 700$ deductible they pay 75% after that for myself so fking complicated what are we doing just cover every one
I agree. The complicated structure of the health plans discourages people from getting treatment and leads to confusing bills and Evidence of Coverage when you do receive care. Unless you work with your health plan on a monthly or quarterly basis, it is all too confusing.
You reconcile the Premium Tax Credit subsidy you have received on your federal income tax return for 2021 with your final income amount. You will be automatically renewed into your current 2021 plan for 2022 at the income stated. If your last stated income on the CC application was from unemployment insurance, and that has ended - with an end date on the CC application - you may be determined eligible for Medi-Cal.
@@KevinKnauss what if someone can’t have medical and the current doc doesn’t accept medical, can this person get auto renew to the same plan with CC, reconcile and pay the price difference when 2022 ends?
@@mathildas757 With Covered California, if you income is below a certain limit, you are determined Medi-Cal, you can't continue in a private health plan through CC with a subsidy. You can apply through CC under "not seeking a subsidy". You would pay the full amount of the health plan. You can also enroll directly with the health plan, which may have a lower premium than CC, without the subsidy, in order to keep your current doctor. You can also have Medi-Cal and a private plan in most situations.
If you are offered a Silver 94 or Silver 87, I would strongly consider it over a Bronze, Gold, or Platinum plan. The Bronze plan may be less expensive per month, but the Silver 94, 87 has no medical deductible for 2024 and much lower health care service copayments. They also have much lower maximum out-of-pocket amounts. Your premium will depend on your age, region of California, and the type of plan you want (HMO, EPO, PPO.)
@@KevinKnauss I live in Alameda county, 53 years old. I am looking for less expensive health plan. Can you suggest me ? Thanks. For example: If I buy Silver 94, 87 or Bronze. How much I have to pay for a year ?
The least expensive health plans in Alameda County will be Kaiser and Aetna CVS, HMO plans. The Anthem Blue Cross EPO will be a little bit more. The most expensive plans will be from Blue Shield the PPO and HMO plans. It all depends on the doctors and hospitals you want in your network.@@MrPhimanh
Hi, I have the option for the platinum 90 $160/month, and the silver 87 for $57/month. For birth which one would you say I would save the most money? Thank you in advance!
The Silver 87 for 2023 has a $3,000 maximum out of pocket maximum, while the Platinum has a $4,500 MOOP. You are saving $100 per month on the premium with the Silver over the Platinum. The copays are virtually identical. Silver 87 coinsurance is 15%, but the Platinum is 10%. Overall, I think I would opt for the Silver 87. There is a higher probability that you will save money.
wow. How is this possible? I'm zero income and platinum PPO Blue Shield is at over $1200 /month right now. I know something really wrong must be going on and I don't know what to do about it . I do have Medi-Cal, but I don't use it because the doctors and the meds i take aren't covered with it platinum PPO for her $160 a month? That's amazing. Please tell me how you figured that out or made that happen.
With the Bronze, your medical deductible is $6,300. Once your responsibility for the first $6,300 is met, you go into 40% coinsurance. That means, the next dollar over $6,300, you pay $0.40 and the health plan pays $0.60. When your deductible plus the 40% coinsurance equals $8,200, the health plan pays 100% of all the covered medical expenses. If your procedure was handled through your Primary Care Physician (excluding emergency services) and received all of the necessary prior authorizations, the health plan should pay their portion of the medical procedure under the terms of the plan.
A $21.50 hrly wage (40 hrs/wk, 12 mons.) would equal approximately $41,280 annual. For a household of two (adult + dependent), the adult would be eligible for the subsidies through Covered California and the dependent would be eligible for Medi-Cal. You would need to earn approximately $46,350 annually for both adult and dependent to qualify for the subsidies through Covered California.
There is no conditional qualification for any of the standard metal tier levels: Bronze, Silver, Gold, Platinum. The Enhanced Silver plans (73, 87, 94) are awarded or offered to the household based on income. You do not have to take the Silver 94 plan offered. You can enroll in a Bronze plan. The Enhanced Silver plans have the same premium rate as the Silver 70 minus any subsidy. A Silver 94 could still be substantially more expensive than a Bronze plan from the same carrier.
Thank you so much Kevin! This is so well broken down and easily digestible. I found this 10000000x more useful than anything on government websites.
You are welcome.
I can’t stress how much I appreciate you making this video! I finally got approved for Medical today and tried to call them to set up a plan, and was so confused. This is super informative, and really helped give me somewhere to start
Great. Helping people make some sense of all this stuff is my goal.
Excellent! Five Star Explanation!
Glad it made sense
THANK YOU! FOR THIS VIDEO - REALLY APPRECIATE IT
Thank you, Kevin. I received the notification you spoke of in my situation to consider Silver Enhanced. Very helpful discussion. I'm going to listen again to the liability discussion toward the end. One has less liability with a Silver Enhanced 73 than a Bronze 60? I don't think you're meaning less exposure; less cash paid out.
The maximum out-of-pocket amount is less with a Silver 73 than a Bronze 60. Once you reach the max out-of-pocket, the health plan covers all network services and prescriptions 100%. In the event so some nasty accident you will be liable for a small dollar amount of medical bills under the Silver 73 than the Bronze 60.
Thanks dude. This helped.
Thank you for this info sir and I have a question, let's say we qualify for the silver 94 due to our annual income for a family of four, but the question is we have about 100k saved, would we still qualify with that type of money in our bank account?
The enhanced Silver plans are offered based on your income, not your savings account. You could have a substantial amount of savings and still qualify for a Silver 94 plan.
@@KevinKnauss your awesome thanks
My husband had a bronze $1/month last year since he has a habit not go to any doctor other than annual checkup. It saves a lot for us. :-)
Check your Covered California account and see how much larger the subsidy is beginning for May 2021. Some people are able to get a Silver 70 plan for $1.
@@KevinKnauss Thank you so much! Will do that for sure! This year, we had to change it to medical, but recently we changed our income level so that we can keep our former doctor. But Somehow, the covered California website doesn’t let me go further screen even though they are saying that we have to choose our insurance plan for June 1st. It’s a bit frustrating.
@@hotpepper4492 There could be two different issues. 1. What does the eligibility results say? If it states Medi-Cal, then the county has not released him from Medi-Cal coverage. That must happen before a plan can be selected. Or 2. When you go to select a plan, navigate to the Enrollment Dashboard and click continue shopping. If he is already enrolled, the system defaults for the dental plan selections. You need to click on the Shop for health plans title and the dark blue line under the dental plan option will switch to the health plans. Then it will ask if you want to change your plan, Yes, Continue Shopping, to choose a different health plan to begin the first of the next month.
@@KevinKnauss
Thank you for your comments! I don’t know what happened, but my insurance agent helped, and he looked over my account. Finally, we could sign up for the enhanced insurance (silver plan 73) from next month. We are glad your UA-cam channel. Otherwise, we wouldn’t know which one we should get. Thank you!!
Wow, I can’t process this at all. The pice I pay for being an artist.
The plan designs and cost sharing seem meant to confuse people. However, you need to pick out a couple of focal points. If you see doctors or other providers on a regular basis (labs, tests, therapy, etc.) and if you take prescription medications, you are almost always better with an Enhanced Silver plan 73, 87, or 94.
Kevin Im a seasoned P&C agent. However looking for some help and mentoring with my Anthem BC BS appt. Do you have some training for sale or would you meet with me for an hourly consulting fee?
On my website, Insuremekevin.com, there is an appointment scheduler app, Calendly. Find a time that works for you and we can chat about your questions. There is never any charge for consultations other than listening to my bad jokes.
@@KevinKnauss Thats awsome! I will try booking an appointment for next week, and I appreciate you offering a consult! Looking forward to your bad jokes :)
My husband have a history of cancer and heart disease. He has operations in the past and we didn't pay anything because of medi cal. Is there a way that he can stay with Medi cal and I'll be in Covered CA if i go back to work soon?
If he is not eligible for Medi-Cal because of a disability (or over 65), then most likely he will be transition to Covered California. However, depending on how much you earn and if you have received unemployment benefits in 2021, your household may be eligible for a very large subsidy and an Enhanced Silver 94 plan. Yes, there will some costs for the health insurance and modest copays, but it is a pretty good deal.
@@KevinKnauss thank you sir! I will be starting work soon and i am scared that my income will go beyond Medi cals income limit. And yes, i am still receiving UI, but we know we can't live off that. So i am really on a hunt of a much better job.
@@lovemy2boyys If the household income is over $24,040 for a household of two adults, then you would be eligible for Medi-Cal. When you do start work, just report the increased income to Medi-Cal so they can make an eligibility determination. It is a really confusing time right now and some of the unemployment benefits won't count against you.
Thanks so much for this helpful video Kevin! I'm currently on MediCal but about to get kicked off soon. Do you happen to know if it's common for insurances to cover surgery on pre-existing injuries that occurred before enrollment? My knee accident occurred while I was on MediCal but requires surgery soon. With my insurance transitioning I'm afraid any new insurance will call it a pre-existing condition and no one will cover it. Anticipating an expensive surgery is a big factor in my decision making around which plan to choose, so was curious if you think most of the plans cover a surgery for a pre-existing condition? ...Based on what I heard you say, I'm thinking I'll probably need a Silver Plan...
Thanks so much for helping to explain.
Have no worries, the surgery will be covered as long as it has been determined medically necessary, which it sounds it has been under Medi-Cal. There are continuity of care provisions within the insurance plans so procedures and treatments approved under one health plan must be covered under a new plan. It happens all the time.
My insurance at work is 200$ a month and a 700$ deductible they pay 75% after that for myself so fking complicated what are we doing just cover every one
I agree. The complicated structure of the health plans discourages people from getting treatment and leads to confusing bills and Evidence of Coverage when you do receive care. Unless you work with your health plan on a monthly or quarterly basis, it is all too confusing.
How to calculate the reconcile amount if under reported the income for 2022? It says there will be an auto renew for 2022.
You reconcile the Premium Tax Credit subsidy you have received on your federal income tax return for 2021 with your final income amount. You will be automatically renewed into your current 2021 plan for 2022 at the income stated. If your last stated income on the CC application was from unemployment insurance, and that has ended - with an end date on the CC application - you may be determined eligible for Medi-Cal.
@@KevinKnauss what if someone can’t have medical and the current doc doesn’t accept medical, can this person get auto renew to the same plan with CC, reconcile and pay the price difference when 2022 ends?
@@mathildas757 With Covered California, if you income is below a certain limit, you are determined Medi-Cal, you can't continue in a private health plan through CC with a subsidy. You can apply through CC under "not seeking a subsidy". You would pay the full amount of the health plan. You can also enroll directly with the health plan, which may have a lower premium than CC, without the subsidy, in order to keep your current doctor. You can also have Medi-Cal and a private plan in most situations.
Hi, If my individual income is from 21-25k anually, what plan I should buy ? How much for per year? Thanks.
If you are offered a Silver 94 or Silver 87, I would strongly consider it over a Bronze, Gold, or Platinum plan. The Bronze plan may be less expensive per month, but the Silver 94, 87 has no medical deductible for 2024 and much lower health care service copayments. They also have much lower maximum out-of-pocket amounts. Your premium will depend on your age, region of California, and the type of plan you want (HMO, EPO, PPO.)
@@KevinKnauss I live in Alameda county, 53 years old. I am looking for less expensive health plan. Can you suggest me ? Thanks. For example: If I buy Silver 94, 87 or Bronze. How much I have to pay for a year ?
The least expensive health plans in Alameda County will be Kaiser and Aetna CVS, HMO plans. The Anthem Blue Cross EPO will be a little bit more. The most expensive plans will be from Blue Shield the PPO and HMO plans. It all depends on the doctors and hospitals you want in your network.@@MrPhimanh
@@KevinKnauss Thank you very much. I may choose to apply for Silver 94 plan.
Hi, I have the option for the platinum 90 $160/month, and the silver 87 for $57/month. For birth which one would you say I would save the most money? Thank you in advance!
The Silver 87 for 2023 has a $3,000 maximum out of pocket maximum, while the Platinum has a $4,500 MOOP. You are saving $100 per month on the premium with the Silver over the Platinum. The copays are virtually identical. Silver 87 coinsurance is 15%, but the Platinum is 10%. Overall, I think I would opt for the Silver 87. There is a higher probability that you will save money.
@@KevinKnauss thank you so much for your response
@@ninagr9140 You are welcome.
wow. How is this possible? I'm zero income and platinum PPO Blue Shield is at over $1200 /month right now.
I know something really wrong must be going on and I don't know what to do about it . I do have Medi-Cal, but I don't use it because the doctors and the meds i take aren't covered with it
platinum PPO for her $160 a month? That's amazing. Please tell me how you figured that out or made that happen.
I was wondering if I’ll be able to use my lacare bronze 60 hmo to pay my 10,000 icl surgery or even some help please
With the Bronze, your medical deductible is $6,300. Once your responsibility for the first $6,300 is met, you go into 40% coinsurance. That means, the next dollar over $6,300, you pay $0.40 and the health plan pays $0.60. When your deductible plus the 40% coinsurance equals $8,200, the health plan pays 100% of all the covered medical expenses. If your procedure was handled through your Primary Care Physician (excluding emergency services) and received all of the necessary prior authorizations, the health plan should pay their portion of the medical procedure under the terms of the plan.
@@KevinKnauss woah I wasn’t expecting a reply THANK YOU SO MUCH !! :)
@@Justecreatif You are welcome.
Hello, I am single and have 1 kid. If I make 21.50hrly. Will I be able to get medical for my child?
A $21.50 hrly wage (40 hrs/wk, 12 mons.) would equal approximately $41,280 annual. For a household of two (adult + dependent), the adult would be eligible for the subsidies through Covered California and the dependent would be eligible for Medi-Cal. You would need to earn approximately $46,350 annually for both adult and dependent to qualify for the subsidies through Covered California.
Awesome video! If you qualify for a lower tier(say bronze), can you still choose silver or gold?
There is no conditional qualification for any of the standard metal tier levels: Bronze, Silver, Gold, Platinum. The Enhanced Silver plans (73, 87, 94) are awarded or offered to the household based on income. You do not have to take the Silver 94 plan offered. You can enroll in a Bronze plan. The Enhanced Silver plans have the same premium rate as the Silver 70 minus any subsidy. A Silver 94 could still be substantially more expensive than a Bronze plan from the same carrier.
@@KevinKnauss Ok cool. Thanks so much for your reply. Very well explained and much appreciated.
@@hottroundzproductions You are welcome. All this subsidy stuff is not necessarily intuitive. Heck, even I forget how some of the programs work.