–Dr. Mark Krugman
How can McComb Insurance Services help me?
Meg will provide prompt, caring service and expertise for these products:
- Major medical, dental, vision, disability income, and life
- Covered California*
- Overseas Travel insurance
- Medicare products
- Long Term Care planning
Why buy health insurance?
Individuals purchase medical insurance for protection from unexpected medical bills that can quickly escalate into financial hardship. More than 50% of reported personal bankruptcies in America are due to unforeseen medical expenses. Starting in 2014, individuals without qualified health insurance will be subject to IRS penalties with few exceptions.
Who can buy individual plans?
The Patient Protection and Affordable Care Act (PPACA) was signed into law March 23, 2010 to help Americans obtain medical insurance regardless of income or health status. Effective January 2014, health care reform mandates that individuals may no longer be declined or rated for preexisting conditions.
What benefits are included?
Starting in 2014, all individual policies must include these essential benefits:
- Ambulatory Patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services; chronic disease management
- Pediatric services, including dental and vision care
What plans are available?
Starting January 1, 2014, individual plans are available in four categories: platinum, gold, silver and bronze. The insurance company is responsible for the following percentages of qualifying medical expenses per plan category:
What premium assistance is available?
Income-eligible individuals may qualify for assistance with monthly premiums and out-of-pocket costs for medical care, as a provision of health care reform. In 2017, individuals who make up to $47,520, and families of four that make up to $97,200, may qualify for financial assistance through the new marketplace or exchange called Covered CA*. The federal subsidy is on a sliding scale, so the greater your income is, the smaller the federal subsidy becomes. All of these contributions are benchmarked to the “silver plan.” By using the Health Plan Calculator*, you can see what your options are and how much coverage would likely cost you.
Medi-Cal provides free or low cost health coverage for those who qualify, including people with disabilities, and those with incomes of less than $16,395 for a single individual and $33,535 for a family of four.
Frequently asked questions:
If I work with an insurance agent, does it increase my premiums?
No, you may work with an insurance agent to navigate through the confusion with no increase in premiums. Agent compensation is included in medical premiums available through Covered California and in the private marketplace.
I already have an individual policy. Do I have to change it?
No, insurance you have in place will not be canceled unless you fail to pay the premium. However, your insurance company will modify your benefit plans to align with health care reform, and premiums may be adjusted accordingly.
When is the next open enrollment period for Covered California?
In 2018, open enrollment will start in November, for a January 1, 2019 effective date.
If I find out I’m eligible for a subsidy for my health insurance premium, do I have to buy a “silver plan”?
No, you can take the designated premium subsidy, and use it to purchase one of the other plan designs: platinum, gold, or bronze.
*“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 McComb Insurance Services, which is solely responsible for its content. This site is not maintained by or affiliated with Covered California, and Covered California bears no responsibility for its content. The e-mail addresses and telephone numbers that appear throughout this site belong to McComb Insurance Services, and cannot be used to contact Covered California.