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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Group vs Individual Coverage

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Question: My wife and I run a small business selling greetings cards. A friend told me that a small group policy is totally the better way to go and that his insurance covers everyting. Would it be a good thing for us my wife is 52 and doesn't smoke. I'm 55 and smoke about a pack a day.

Answer: A small group policy may be a good way to go if you or your wife has a health condition that would render you ineligible for individual coverage. You would be subject to a Rate Adjustment Factor (RAF) depending on your health, the number of members in your plan and the number of COBRA enrollees as well as the company and state in which you are applying. This could make your group plan premiums expensive especially if you choose a benefit-rich plan however coverage would be guaranteed.

If you are both healthy then individual coverage may be a better choice for you based on the lower premiums. Can you give more information about your health history. Do you or your wife take any prescription drugs? Have you had any surgeries in the past 5 years? Is there a health condition for which you see a doctor or would be considered under a doctor's care for?

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