Speak with a Covered California certified agent! Call (888) 413-3164 or Shop Online Now

Shop and Compare

California Health Insurance Plans and Rates

It's easy. Just enter your zip code.

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.

2016 Covered California Plan Benefit Changes?

By on | 1 Comment

Question: I have heard of the limit to tier 4 drugs. Can you elaborate on this as well any other changes like deductibles, co pays, coverage e passion etc?

Answer: In 2016, all metal-tier plans will now have a maximum monthly out-of-pocket cost on specialty drugs (once the pharmacy deductible is met). For the Bronze Plans there is a $500 monthly maximum and for Silver, Gold, and Platinum the monthly out-of-pocket maximum is $250 after the pharmacy deductible is met. The other significant change in benefits for 2016 affects the Bronze Plan. The first cumulative three visits will not be subject to a deductible and can include a specialist visit in addition to primary care, mental health and urgent care visits. In addition, laboratory work is not subject to the deductible.

1 Comment

A September 16, 2015 article written by Brian M. Kalish and posted on the Employee Benefit News website decries the fact that, nationally, some 2.2 million consumers who failed to use the free services of an authorized and licensed insurance agent when enrolling in an exchange-based health plan for 2015 also failed to enroll in Silver tier plans which would have provided them with cost-sharing reductions that might have saved them thousands of dollars in out-of-pocket expenses for health care and prescription medications.

I can tell you that 100% of the individuals and families who have received my assistance in the enrollment process since October 2013 who were eligible for CSRs obtained them, and my guess is that an overwhelming majority of other Certified Insurance Agents here in California and licensed agents in other states can also make the same statement. On the other hand, untrained Navigators and Enrollment Counselors are largely responsible for leading persons to the plan with the lowest premium cost and exposing those persons to unnecessary deductibles, copayments, and coinsurance expenses.

You can find the article here http://ebn.benefitnews.com/news/exchanges/public-exchange-enrollees-missing-out-on-cost-sharing-reductions-2747314-1.html or email me for a transcribed copy.

Leave a comment

Do You Have California Health Insurance Questions?

Ask An Expert

View Previous Questions
Call Us at (888) 413-3164

© 2022 California Health Benefit Advisers, LLC
Home / About / Start Shopping / Ask a Question

“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. This web site is owned and maintained by California Health Benefit Advisers, LLC, which is solely responsible for its content.