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

In case you are 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 just a few the explanation why this can be the case.

In case you are not in your father or mother’s insurance coverage, or if they aren’t insured, chances are you’ll be trying to get your personal protection. Nevertheless, understand that you’ll be able to legally stay in your father or mother’s medical health insurance till you’re 26. This was a change that was carried out by the Reasonably priced Care Act when it grew to become efficient again in March 2010.

One other situation could merely be that you’ve chosen to buy your personal medical health 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 best way, you must also know that companies which have 50 or extra workers are required to supply inexpensive well being care protection choices for workers. And, the state’s well being alternate market, Coated California, factors out,

“Small enterprise house owners with fewer than 50 full-time workers will not be required to supply well being care protection to their workers. Nevertheless, you must know that if a small enterprise with fewer than 50 full-time workers 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 unbiased contractor or a younger entrepreneur and enterprise proprietor. In that case, you probably must discover your personal well being plan.

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



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

As a wholesome, youthful particular person presumably nonetheless single, chances are you’ll think about medical insurance coverage pointless. Nevertheless, irrespective of how wholesome and match chances are you’ll be, issues occur. Very like auto insurance coverage, whilst you don’t make use of it every single day, while you’re in an accident, you definitely need it.

Equally, in case you had been to journey whereas happening some stairs and break your arm, you’ll be glad to have medical health insurance. That’s largely as a result of even the essential value for treating a fractured arm could be over $6,000 with out insurance coverage. And that’s for a easy break. You probably have extra advanced accidents, chances are you’ll be billed rather more.

That’s as a result of every thing related to medical care prices cash – and normally fairly a little bit of it.

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

Actually, the common value of a hospital keep could be as a lot as $10,000 a day.

And together with an inexpensive medical health insurance plan and coverage, it might smart to acquire imaginative and prescient insurance coverage, dental insurance coverage, and complete prescription drug protection, as effectively.


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

Market medical health insurance plans are designed to fulfill numerous wants. The three most typical plan varieties, nonetheless, are PPO, HMO, and EPO plans. Here’s a temporary rationalization of every:

PPO, or Most well-liked Supplier Group, is a kind of well being plan that lets you pay much less in case you use suppliers within the plan’s community. You should use medical doctors, hospitals, and suppliers outdoors of the community and not using a referral for a further value. Members have a yearly deductible they’ll be required to fulfill earlier than protection begins for his or her medical payments, together with a month-to-month premium. As well as, there may be additionally a copayment for sure companies.

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

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

EPO, or Unique Supplier Group plans are just like HMO in that companies are coated provided that you employ medical doctors, specialists, or hospitals within the plan’s community besides within the case of emergencies. There may be sometimes a decrease premium than with a PPO provided by the identical insurer. With an EPO, you will have restricted decisions on your well being care suppliers though probably greater than by an HMO.




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

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

What are premiums in medical health insurance?

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

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

What are deductibles in medical health insurance?

That is the quantity you pay for coated well being care companies 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 coated companies your self. That is fairly just like the deductible you will have in your auto insurance coverage.

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

What’s a medical health insurance copay?

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

An instance may be a normal workplace go to. In case your medical health insurance plan’s allowable value for a physician’s workplace go to is $150, your copayment for a physician’s go to may be simply $20. For those who haven’t met your deductible but, you’d pay the total allowable quantity for the go to of $100. If, nonetheless, you’ve paid your deductible you’d solely pay $20, typically on the time of the go to.

Usually, well being plans with decrease month-to-month premiums have greater copayments. Plans with greater month-to-month premiums normally have decrease copayments.

What’s coinsurance?

The proportion of prices of a coated well being care service that you could be be required to pay after you’ve paid your deductible, typically 20 p.c most often.

In accordance with the web site at,

“Not all medical companies are topic to coinsurance, and never all Obamacare plans include a coinsurance requirement. Typically talking, costlier or greater 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 health insurance in California is definitely fairly simple.

One standard strategy is to easily apply for medical health 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 health insurance protection to uninsured Individuals.

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

By means of Coated California, people can apply for medical health insurance throughout what is called Open Enrollment. This can be a window of time when workers have to decide on or change their protection for the approaching 12 months. For instance, Open Enrollment for 2023 begins November 1, 2022, to get medical health insurance from The Market.

In case you are at the moment unemployed, chances are you’ll be questioning how one can get medical health insurance and not using a job?

The excellent news is that this can be a actual risk with Coated California. As their web site states, people who find themselves unemployed could possibly get an inexpensive well being plan by the state’s Market based mostly on their family measurement and revenue.

Another choice is qualifying totally free or low-cost protection by Medi-Cal.



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

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

Discovering the precise medical health insurance plan in California could 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 totally different medical health insurance choices, there’ll probably be many questions and issues. And we invite you to deliver your questions on well being protection insurance coverage to us and you’ll be assured that JC Lewis Insurance coverage Providers will assist you discover the precise options on your medical health insurance wants.

So, name us in the present day for extra data or request a quote on-line.




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