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Well being Insurance coverage 101 With J.C. Lewis Insurance coverage Companies

If you’re a younger grownup residing in Northern California between the ages of 18 to 25, it’s fairly attainable that you simply wish to get your personal insurance coverage for the primary time.

There are a number of explanation why this can be the case.

If you’re not in your guardian’s insurance coverage, or if they aren’t insured, it’s possible you’ll be trying to get your personal protection. Nonetheless, needless to say you possibly can legally stay in your guardian’s medical insurance till you’re 26. This was a change that was applied by the Reasonably priced Care Act when it turned efficient again in March 2010.

One other state of affairs could merely be that you’ve got chosen to buy your personal medical insurance both as a result of your employer doesn’t supply it, otherwise you don’t need what’s being provided by your organization.

By the way in which, you also needs to know that companies which have 50 or extra staff are required to supply reasonably priced well being care protection choices for workers. And, the state’s well being change market, Coated California, factors out,

“Small enterprise homeowners with fewer than 50 full-time staff will not be required to supply well being care protection to their staff. Nonetheless, you need to know that if a small enterprise with fewer than 50 full-time staff does supply protection, then that protection should adjust to the necessities of the ACA.”

And, thirdly, it’s fairly attainable that you’re self-employed both as an impartial contractor or a younger entrepreneur and enterprise proprietor. In that case, you almost certainly must discover your personal well being plan.

No matter whether or not you keep in your guardian’s coverage, go along with a plan provided by your employer, or select to search out your personal medical insurance plan, you continue to have to have protection.



Since 2020, Californians are required by state legislation to have medical insurance. This legislation is known as an “particular person mandate” as a result of all people in California are mandated to be lined by medical insurance.

As a wholesome, youthful particular person probably nonetheless single, it’s possible you’ll contemplate medical insurance coverage pointless. Nonetheless, regardless of how wholesome and match it’s possible you’ll be, issues occur. Very like auto insurance coverage, whilst you don’t make use of it daily, whenever you’re in an accident, you definitely need it.

Equally, when you have been to journey whereas taking place some stairs and break your arm, you’ll be glad to have medical insurance. That’s largely as a result of even the essential price for treating a fractured arm may be over $6,000 with out insurance coverage. And that’s for a easy break. You probably have extra complicated accidents, it’s possible you’ll be billed rather more.

That’s as a result of the whole lot related to medical care prices cash – and often fairly a little bit of it.

For instance, any journeys in an ambulance, drugs given, medical tools and provides used, X-rays and different imaging providers, in addition to the physician’s and nurse’s time all add up in a short time. And when you should keep within the hospital for even a brief period of time, the prices add up even quicker.

In actual fact, the common price of a hospital keep may be as a lot as $10,000 a day.

And together with an reasonably priced medical insurance plan and coverage, it might clever to acquire imaginative and prescient insurance coverage, dental insurance coverage, and complete prescription drug protection, as nicely.


Strictly talking, there are greater than half a dozen several types of Market medical insurance “plans” obtainable in California, together with what is named a high-deductible well being plan, or HDHP, which is a medical insurance coverage that has a decrease month-to-month premium and a better deductible. These are extra in style with youthful members and are sometimes paired with Well being Financial savings Accounts or an HSA.

Market medical insurance plans are designed to satisfy numerous wants. The three commonest plan sorts, nonetheless, are PPO, HMO, and EPO plans. Here’s a transient clarification of every:

PPO, or Most well-liked Supplier Group, is a kind of well being plan that lets you pay much less when you use suppliers within the plan’s community. You should utilize docs, hospitals, and suppliers outdoors of the community with out a referral for a further price. Members have a yearly deductible they’ll be required to satisfy earlier than protection begins for his or her medical payments, together with a month-to-month premium. As well as, there’s additionally a copayment for sure providers.

A Well being Upkeep Group, or HMO, is a kind of medical insurance plan that usually limits protection to care from docs who work for or contract with the HMO. It usually gained’t cowl out-of-network care besides in an emergency. An HMO could require you to reside or work in its service space to be eligible for protection. Then again, nonetheless, members often have decrease out-of-pocket.

In an HMO, visits to specialists require a referral from their PCP, or Main Care Supplier. Though HMO members usually have a copayment for providers, they will not be required to pay a deductible earlier than their protection begins.

EPO, or Unique Supplier Group plans are just like HMO in that providers are lined provided that you utilize docs, specialists, or hospitals within the plan’s community besides within the case of emergencies. There’s usually a decrease premium than with a PPO provided by the identical insurer. With an EPO, you’ll have restricted decisions on your well being care suppliers though doubtless greater than by means of an HMO.




All medical insurance entails prices. Whereas these prices may be considerably lowered with a backed well being plan bought by means of the state Market, Coated California, there’ll at all times be prices, nonetheless.

Here’s a fundamental overview of widespread prices related to medical insurance protection.

What are premiums in medical insurance?

That is the month-to-month price that you’ll pay on your medical insurance no matter whether or not you utilize your protection or not. Whereas it’s the major price most customers have a tendency to have a look at when selecting a plan, together with a premium, you’ll often should pay different prices akin to an annual deductible, copayments, and coinsurance.

In case you qualify for a Market well being plan, you could possibly decrease your premium prices with a tax credit score.

What are deductibles in medical insurance?

That is the quantity you pay for lined well being care providers earlier than your insurance coverage plan begins to pay. In case your plan has a $2,500 deductible, for instance, you’ll pay the primary $2,500 of lined providers your self. That is fairly just like the deductible you’ll have in your auto insurance coverage.

After you will have paid your deductible, nonetheless, you then pay solely a copayment or coinsurance for lined providers and your insurance coverage firm pays the remaining. Typically, plans with decrease month-to-month premiums have increased deductibles, whereas well being plans with increased month-to-month premiums could have decrease deductibles.

What’s a medical insurance copay?

Copayments, or copays, are a hard and fast quantity ($15 or $20, for instance) that you’re required to pay for a lined well being care service after you’ve paid your deductible.

An instance is likely to be an ordinary workplace go to. In case your medical insurance plan’s allowable price for a health care provider’s workplace go to is $150, your copayment for a health care provider’s go to is likely to be simply $20. In case you haven’t met your deductible but, you’ll pay the total allowable quantity for the go to of $100. If, nonetheless, you’ve paid your deductible you’ll solely pay $20, usually on the time of the go to.

Usually, well being plans with decrease month-to-month premiums have increased copayments. Plans with increased month-to-month premiums often have decrease copayments.

What’s coinsurance?

The share of prices of a lined well being care service that you could be be required to pay after you’ve paid your deductible, usually 20 % most often.

In response to the web site at,

“Not all medical providers are topic to coinsurance, and never all Obamacare plans include a coinsurance requirement. Typically talking, costlier or increased metal-level plans (like platinum plans) could not require you to pay coinsurance. Coinsurance shouldn’t be confused with different type of cost-sharing akin to copays or deductibles.”



The excellent news is that getting medical insurance in California is definitely fairly simple.

One in style strategy is to easily apply for medical insurance from The Market, often known as Coated California. The healthcare Market, often known as The Well being Insurance coverage Market or just The Market, was established by the Reasonably priced Care Act as a method to increase medical insurance protection to uninsured People.

Many states supply their very own market, together with California, which may be discovered at

By Coated California, people can apply for medical insurance throughout what is named Open Enrollment. This can be a window of time when staff have to decide on or change their protection for the approaching yr. For instance, Open Enrollment for 2023 begins November 1, 2022, to get medical insurance from The Market.

If you’re presently unemployed, it’s possible you’ll be questioning the best way to get medical insurance with out a job?

The excellent news is that it is a actual risk with Coated California. As their web site states, people who find themselves unemployed could possibly get an reasonably priced well being plan by means of the state’s Market based mostly on their family dimension and earnings.

An alternative choice is qualifying totally free or low-cost protection by means of Medi-Cal.



At J.C. Lewis Insurance coverage we need to be your insurance coverage associate and we provide high quality medical insurance plans solely from the main medical insurance carriers licensed to do enterprise in California.

We’re a family-owned and operated medical insurance company positioned in Sonoma County, California. We concentrate on discovering and managing medical insurance coverage not just for people, however for households and small companies, as nicely, and we’re licensed and licensed by every insurance coverage service we characterize.

Discovering the appropriate medical insurance plan in California may be difficult and there are numerous choices to select from. For instance, in case your employer doesn’t supply well being advantages, an particular person plan could also be the best choice for you.

At J.C. Lewis Insurance coverage we perceive that when contemplating completely different medical insurance choices, there’ll doubtless be many questions and considerations. And we invite you to convey your questions on well being protection insurance coverage to us and you’ll be assured that JC Lewis Insurance coverage Companies will enable you to discover the appropriate options on your medical insurance wants.

So, name us at this time for extra data or request a quote on-line.





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