Covered CA

Bronze plans have the lowest monthly costs on average, but you should be prepared to spend more than $7,000 if you were to become seriously ill, have an accident or be hospitalized. When you receive care, your costs will be high. Free preventive services include annual wellness visits, certain screenings, immunizations, prenatal care, children’s vision care and preventive and diagnostic children’s dental care.

If you see your doctor four or five times a year or fill one or two prescriptions, you may want to look into Silver plans, which are more protective and take better care of you. Silver plans have moderate monthly costs and moderate expenses when you get care.

High-deductible health plans (HDHPs) are only available through Bronze plans. These plans let you open a health savings account, or HSA, which lets you set aside funds pre-tax for care you may need. Money you put in this account rolls over year to year if you don’t use it. HDHPs are a great option for people who want to take charge over their health care needs and expenses and don’t expect to use non-preventive medical services often.

The Bronze level’s high-deductible health plans (HDHPs) have what are known as integrated deductibles, meaning that your medical, pharmacy and dental deductible are combined. When you pay for a prescription, for example, that money is going toward your medical deductible too. You’ll get to the point where your plan pays for all services that much sooner.

Services covered by your health insurance plan are ready to be used starting the next month after you make your first payment, even before your membership ID card has arrived.

Be sure the doctor or provider you want to see is participating in your health plan network. If you visit the provider before you receive your membership ID card, you may be asked to sign a statement agreeing to pay for the services if you can’t prove you have health insurance.

The provider may later send you a bill for the care. By the time you get a bill or claim from your provider, you will most likely already be entered into your health insurance company’s system. Once you have your membership ID card, simply contact your provider, provide them your membership ID card number and ask to have the bill resubmitted directly to your health insurance company.

Your plan may require you to have a primary care clinician. Your primary care clinician will help you navigate the health care system when you need assistance with specialty care, coordinating your care with other providers and helping you understand your treatment options. You can change your primary care clinician at any time.

If your new health insurance does not work with your doctor, but you are getting treatment for a serious condition, call your new health insurance company to let them know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health insurance company may be able to work with your current doctor while you finish treatment. Be sure to tell your current doctor that you have new health insurance.

For questions about medications and getting your prescriptions filled, the first step is to contact your health insurance company to see if it has received your first payment and can issue you a membership ID card or a plan identification number. Ask which pharmacies you can use in order to get the pharmacy benefits of your health insurance plan.

When the information that you put on your application changes during the year, you must report it. Changes to things like your address, family size and income can affect whether you qualify for Medi-Cal or get help paying for your health insurance through Covered California.

People with Medi-Cal must report changes to their local county office within 10 days of the change. If you have health insurance through Covered California, you must report changes within 30 days.