Rising healthcare costs can be rather discouraging. Fortunately, in California, there are tiers and subsidies to help lower the cost of healthcare insurance.
The price you pay generally depends on your age, the coverage tier of your choice and other factors such as health needs. As you grow older, your health insurance price may increase. Regardless, a range of $254 - $393 should cover your monthly insurance premiums.
Getting insurance can be quite difficult, especially if you don’t qualify for subsidies. It doesn’t help that California is one of the states that legally requires individuals to have health insurance. There are so many unknowns about healthcare and insurance in California but this article aims to help you understand the cost aspect.
What Is The Median Non Subsidized Cost Of Health Insurance In California?
If your income happens to exceed the 600% Federal Poverty Level as mandated by the California law, you would not be able to get your health insurance subsidized. The average statewide monthly cost for a non-subsidized health insurance benchmark plan is $462. This is the average price of the Silver benchmark plan.
How Do You Know If You Qualify For A Subsidized Health Insurance Plan?
To qualify for a federal government tax subsidy, your annual income for that year has to be between 100% to 400% of the FPL or federal poverty level. This means that you have to earn between:
- $12,500 to $49,970 as a single individual
- $16,920 to $67,650 for couples
- $25,800 to $104,000 for a family of 4
California subsidies aim to continue from where the federal government subsidies stop. They are based on federal guidelines and are available to people who earn $75,000 annually and families of four that earn a maximum of $154,500.
California’s highest health insurance subsidies are given to those that earn the least. This means that the least eligible earners might get enough assistance to have their whole monthly premiums paid off.
The Average Price of Health Insurance For California Families
For a Californian family of four, the median monthly premium for health insurance not subsidized by the government is $1,440. This is a slight increase from the monthly premium costs of $1,400 recorded in 2019.
The type of plans selected also affect how high or low the monthly premiums are. Typically when a plan offers more coverage, the higher its monthly premium is. Family coverage for a minimum of 2 people saw premium prices rise with just the Bronze tier premium decreasing year on year.
- Bronze Health Insurance Plan went from $1,080 in 2019 to $1,040 in 2020
- Silver Health Insurance Plan went from $1,180 in 2019 to $1,215 in 2020
- Gold Health Insurance Plan went from $1,426 in 2019 to $1,440 in 2020
- Platinum Health Insurance Plan went from $1,460 to $1,620 in 2020
What Are The Other Costs Associated With Health Insurance?
Monthly premium costs are just a portion of the overall price of health insurance. It would help if you also considered the out of pocket expenses you need to cover before your health insurance covers the service and the annual deductibles. On average, the deductible on a family plan for 2020 rose 5% to $8,440 from the previous year. The median family deductible for a family of 4 last year was $7,770.
The following table highlights the most inexpensive health insurance policies for all the tiers, their maximum out-of-pocket costs, their deductibles, and of course, the monthly premium a 40-year-old individual would have to pay. These plans should be seen as a base to evaluate what type of coverage you require accurately and the expected associated cost of each tier.
California’s Mental Health Insurance Tiers
Health insurance in California is provided via four varying metal tiers, with Bronze being the lowest and Platinum being the highest. As seen from the table, Gold and Platinum tend to have the most expensive monthly premiums coupled with the lowest deductible values.
Bronze and Silver’s lower tiers work in the inverse, with affordable monthly premiums and extremely high deductibles. For instance, the Gold plan’s monthly rate is about 30% more than the Bronze plan’s monthly cost.
One of the major factors on which the cost of health insurance is determined is age. In California, the older you typically are, the more you pay for health insurance. For instance, a 40-year-old Californian on the Silver health insurance plan would pay on average 28% more for the same coverage a 21-year-old would.
These rises in monthly premiums tend to grow even bigger as you age. For example, you might find that a 60-year-old senior in California pays 113% more than the 40-year-old pays for the same Silver health insurance plan.
The trend follows the logic that younger people are generally healthier, and older people are more victims of health crises and needs than younger people. Simply put, the older a person gets, the more susceptible they are to illnesses.
What About Health Insurance For Seniors?
Seniors in California have a vast array of options to select from when it comes to health insurance. For the most part, the CDI or California Department of Insurance regulates the health insurance plans underwritten by California insurance companies. What this means is that the CDI does not regulate some options available to seniors such as Medicare, and it would be unable to help if you run into an issue or require assistance
Also known as Original Medicare, Medicare describes the federal government-funded insurance program that is open to eligible individuals aged 65 or more. There are two parts to Medicare, with Part A covering most of a senior’s inpatient care and hospital services while Part B covers most outpatient medical services and some prescriptions.
It is important to note that Medicare doesn’t cover all of your insurance costs. It is recommended that you buy a health insurance policy such as Medicare Supplement Insurance or a Medicare Advantage plan alongside your Medicare plan. This is to help cover any additional health care costs and get more comprehensive healthcare at an affordable price.
Getting Medicare Supplement Insurance in California
To get a Medicare Supplement plan in California, you must be enrolled in both Medicare Part A and B Original Medicare. Medicare Supplement Insurance, also called Medigap, offers coverage for gaps in healthcare-related expenses not typically covered by Medicare. Fortunately, Medicare Supplement Insurance plans are typically standardized, offering numerous benefits to you as you offset your medical-related costs.
Medicare Part C in California
Medicare Part C, also known as Medicare Advantage, helps merge medical services coverage such as doctor visits and hospital care into a single plan. Since most Medicare Advantage plans are standardized throughout the country, you’ll get the same coverage in California as anywhere else in the country. However, depending on your provider, there may be additional benefits such as gym and fitness memberships. Medicare Part C plans such as HMO and PPO offer a comprehensive list of health coverages.
Medicare Part D in California
The Medicare Part D plan is a prescription drug package open to beneficiaries of Medicare. While private entities sell prescription drugs, they have to be first approved by Medicare. This means that, before you buy a prescription plan, you must ensure that the plan in question is one that has been Medicare-approved. Certain drug plans come with different rules on the types of drugs covered and the drug categories.
It is imperative to ensure the plan you end up purchasing covers any type or brand of drugs under your current prescription. One of the great things about Medicare Part D is that you do not have to be signed up for the traditional Medicare plan to benefit from it. It can be purchased as a standalone prescription drug plan.