2025 Health Insurance Plans Explained compare bronze silver gold and platinum (California)

If you're shopping for medical insurance for year 2025, this presentation will help you decide what health insurance options work best for you and your family. I am an independent and licensed insurance agent in California, helping people enroll into affordable and high quality individual, family, and group health insurance plans. I have contracts with all major medical insurance companies in the state and can compare all of the options, discuss about advantages and disadvantages of some, and answer any questions you might have. Even if you're shopping for health insurance by yourself and you don't necessarily want me as your agent, the information presented in this video will definitely help you see a clear picture and make an educated decision and possibly save money on your health insurance premiums for next year. If you would like me to be your agent of record in Covered California, I am happy to be of assistance. Feel free to reach out. I am a Covered California certified insurance agent as well as represent all health insurance carriers in the state directly and you can easily find me and delegate me and I can help at no cost. My services are free to the consumers because insurance companies pay me directly when I submit an application on your behalf and there is no extra fee or cost added to your premium if you work with me or with another licensed agent. Okay, so now let me tell you all the good stuff that you want to know about health insurance. Keep in mind that all medical plans cover the same basic health care services but may vary in other ways such as provider networks, premiums, your out-of-pocket cost and prescription drug coverage. So let's go over a few important things that you need to keep in mind when selecting a health insurance plan. First, you will have to look at what's available on the market. Well, that's obvious, right? You can easily run a quote on the official website or ask an agent for help. Make sure you check for the subsidies as those are quite generous and those are available through Covered California if you live in this state. I want to say that these subsidies could save you money on the same private insurance plans as Blue Shield, Kaiser, Anthem Blue Cross, Health Net, VHP, Aetna and so on. You will be surprised that there are zero premium plans available for those who qualify. Here's a very useful table that I use daily to quickly check for eligibility for my clients and you can get a copy of this table on my blog. I will post a link below. Keep in mind though that subsidies are available beyond the income limits that you see here. So I encourage you to run a quote and get a clear answer on the qualification for your specific situation. Run a quote even if you believe that your income is too high. Just for the sake of it, spend five minutes and do that. Now one more thing when selecting a health insurance plan, keep in mind that there are four main categories of plans bronze, silver, gold and platinum. The plan designs are the same among companies. In other words, if you are comparing Kaiser bronze with the Blue Shield bronze plan, you will have absolutely the same deductible, same copay, same out-of-pocket max. However, keep in mind that all, absolutely all silver plans available on the Covered California have zero deductible. The income doesn't matter. Even if you apply for health insurance via Covered California, then you have access to the zero deductible plan, silver plans, right? So this is only available through Covered California and if you want a silver plan with zero deductible, that's where you can find it. Also, there are additional types of bronze plans. There could be an HDHP plan or HSA plan and so on. You will have to look at the specifics and understand the plan benefits before selecting them because those could be different. Okay, so keep in mind that don't look only at the cost and deductible. This will basically tell you nothing about the medical insurance plan. A deductible is a totally different story and if you don't understand how deductibles work with bronze plans, then you pay lots of extra money each month for no deductible plans without any reason, like for a gold one, right? I'll explain this later, but for now, just keep in mind that knowing how the deductible works can help you in many ways. So you're looking at these metal tiers and are totally confused. Which one do you get? Well, the idea is that a bronze plan being high deductible is a good option for those who rarely see a doctor and want a plan with lower premiums for catastrophic coverage. If you are healthy and see a doctor two or three times per year, a bronze plan might be a good option for you. Just think about what your expectations are for the next year and you can easily figure out if that's the case, if that's your plan. Although it's hard to predict if you're going to get injured or pregnant or sick in the coming year, well, leverage what you know about your health needs and this will help you make a decision now. Another thing, when comparing health insurance plans, it's wise to look at a side-by-side comparison of all of them, right? So let's go over the basics of all the plans. As you can see, all these allow you to have an annual wellness exam at no cost. Now, pay attention. This is very important for bronze plans. If you don't pay the deductible for any primary care doctor visits, same rules apply for urgent care. The co-pay for the primary care visit and urgent care is $60 fixed. The lab is also not subject to deductible and it's $40 flat fee. The cost for specialist visit is $95 for the first three visits. If you see a specialist a fourth time in a year, then it becomes subject to deductible and you pay more, right? This might be a good plan for those that are healthy and rarely go to the doctor. Obviously, if you need more care, you will have to pay more out-of-pocket with a bronze plan. The maximum out-of-pocket you pay with this plan is $8,850 for an individual or double for the family. The out-of-pocket max is what you pay in the worst case scenario and it basically includes the deductible and everything you pay, co-insurance, co-pay, and so on. You know, everything you pay out of your pocket goes towards this annual amount and this is the maximum you pay throughout the year out of your pocket. Now, let's look at the silver plan. As I mentioned earlier, if you apply for health insurance through Covered California, then your silver plans have zero deductible. And if you apply directly with the insurance companies or renewing your silver plans, take a look at the benefits for next year as this could dramatically impact you out-of-pocket costs. The silver plan offers a great value. And so, take a look at it and study the benefits. You do not have a deductible and will have to pay a fixed co-pay for various medical procedures with the silver plan like labs, ultrasounds, emergency room visits, and so on. I have a link to my website with detailed summary of benefits for most of the insurance plans, so check it out. By studying the summary of benefits for your specific plan, you will be able to understand the benefits and avoid mistakes and avoid overpaying for medical care. Now, moving on to the gold plan. It has no deductible. The co-pays and co-insurance are lower or very similar to the silver plan. This plan costs more each month and the insurance pays on average about 80% of your medical cost and you pay the rest. The same out-of-pocket rules apply here. The platinum plan has no deductible. The co-pays, co-insurance are lower than those for the gold plan. This plan costs more each month, but the insurance pays on average 90% of your medical cost and you pay the rest. Obviously, the platinum plan has the highest premium each month. If you're healthy and rarely go to the doctor, it might not be a good idea to buy the most expensive plan on the market, so you don't really need to buy a platinum plan unless you have to do surgeries or expect extensive hospital visits or treatments. Now, we haven't discussed about the minimum coverage plans. These are high deductible plans available to those who are under the age of 30. With these plans, you basically pay everything out-of-pocket except for the three visits to your primary care doctor. These plans tend to have a bit high out-of-pocket expenses and if the cost of bronze plan is not dramatically higher, I would rather recommend that you consider a bronze plan instead. Also, these plans don't qualify for subsidies, so again, pay attention and choose wisely. Feel free to reach out to us in case you doubt your choice of plans or have questions. Details on how to reach out to us are in the description of this video or in the first comment. Also, we haven't discussed the enhanced silver plan 73, 87, and 94. These plans offer lower co-pays, co-insurance, and out-of-pocket costs for those who qualify. Everyone applying through Covered California will qualify for silver 73 plan, but higher levels of coverage such as 87 and 94 plans will be based on income limits. I recommend that you are very careful when completing the application for health insurance. I've seen many people rushing through the Covered California application and losing the enhanced silver benefits because they have made a minor mistake on the application. It's very important to include the income correctly. Also, I have also witnessed people incorrectly entering the income into the Covered California and then the application is referred to the Medi-Cal program and it gets stuck there for many, many months and nothing could be done until a social worker corrects it and sends back to Covered California. So, it's best to get it done correctly the first time and avoid all these mistakes. In case you run into an issue with your Covered California application and need help, feel free to reach out to me and I can assist. There is no cost for my help, as I said earlier, and you can easily find me in the Covered California and give me permission to fix the problem and assist you with the eligibility and plan selection and so on. This is a confidential help. I'm a licensed insurance agent and I follow all the rules, regulations, including privacy and ethical considerations. In the description of this video, I have step-by-step delegation instructions that you can use to give me permission to your Covered California account so I can help. Okay, so there is one more thing you might come across while shopping for health insurance and that is PPO or HMO. HMO is the health maintenance organization, so Kaiser would be an HMO and PPO is a preferred provider organization, so Blue Shield would be a PPO, although they have HMOs as well. So, those are two most common types of health insurance plans. HMOs typically offer lower premiums but have more restrictions, such as requiring referrals from a primary care physician. PPOs generally have higher premiums but offer more flexibility, allowing you to see specialists without referrals and visit out-of-network providers, though at a higher cost. EPO is exclusive provider organization and it's like a combination of these two. Okay, and lastly, I have to mention about the penalty. If you are in California and you don't have health insurance, then you may have to pay a penalty unless you qualify for an exemption. The penalty is either 2.5% of your adjusted gross income or $850 per person and half of that for a child. The penalty is either the percentage or the filed fee, depending on what's more. Well, that's about it for medical insurance. If you would like to learn more about dental insurance, I have created a separate video where I explain all the details of dental insurance plans and give useful and practical advice on the options that will help you save money on dental insurance and eventually on dental care costs as well. If you need help with making sense of your health insurance options, feel free to reach out to us. This is exactly what I have been doing for the last several years and have helped many, many individuals in California save money on their health care while choosing the best medical insurance plan. I am a licensed and certified insurance agent in California and by law I'm not allowed to charge anything for my services and your premium will not be higher if you work with me. So basically, I'm offering qualified free help at no extra cost to you. That's all for now. If you