California Health Insurance - Alternative to marketplace?

November 29, 2017 11:08 AM

Is buying health insurance directly from a carrier, versus through the Covered CA marketplace, any cheaper for somebody who doesn't qualify for subsidies? The cost increase this year (27%!) has me thinking about options.

So I don't qualify for any subsidies, but it was convenient to use the Covered CA marketplace to compare plans and purchase mine. Before I go onto the websites for the major carriers and dive into trying to compare their privately-available direct sale plans, has anybody already done this? Am I going to be wasting my time, or is there any hope of finding cheaper comparable plans there or through a broker? The only broker I have called told me to go on the marketplace.

posted by bluesky78987 to Health & Fitness (3 answers total)

It may be possible but you may end up with a plan that isn't ACA-compliant and so doesn't have the protections that ACA plans have. I would look at the plan documents very, very carefully to make sure you're not signing up for something that could end up being much more expensive if you need care. Key things to check: is there an out-of-pocket maximum? Is medication covered? Mental health?

Insurance companies don't make massive profits by selling high-value plans at bargain rates. As with everything else, you get what you pay for. And the insurers are much better at calculating risk than you are. If it looks too good to be true, it is: find the loophole(s) and decide if they're worth the risk for you.

You may also* have to pay a fee for not having ACA-compliant insurance, with a floor of $695/adult but which will probably actually be 2.5% of your income -- so figure that in as well to your cost-benefit analysis.

*As of this writing: there are Noises about the current Administration refusing to enforce the penalty and/or Congress amending the penalty to $0, effectively cancelling it. But it's not a good idea to make decisions assuming that will happen.
posted by tivalasvegas at 11:45 AM on November 29, 2017 [2 favorites]

I had a broker help me, although I did most my research on the Covered CA site. She spent half an hour on the phone with me explaining options and answering questions which was all I needed. Then she sent me a link to a form on the provider's web site to sign up. (Haven't done that part yet!)

One thing she told me was that the prices for Silver plans on Covered CA were a bit higher than they would be buying directly from the insurer. I think this is for the exact same plan and don't quite understand it.
posted by Nelson at 12:58 PM on November 29, 2017

Response by poster: This is very interesting so far. Another thing I have found is that the rate varies GREATLY based on zip code. A friend of mine was quoted 1002 when she used her Palos Verdes address, versus 1250 using her norcal (bay area) zip.

Nelson, would you be willing to share your broker's name?
posted by bluesky78987 at 1:13 PM on November 29, 2017