For individuals and families, we bring our 30 years of experience and a passion for finding the right match between the benefits and cost of individual health, dental, and life insurance programs for both under-65 and Medicare-eligible clients. Please contact us for assistance arranging just the right plan. In the meantime, if you’d like to see some numbers, click the button below to get your own personalized health insurance quote.
There is no difference in rates no matter how or where you buy coverage, so you won’t find lower prices for the quoted plans anywhere else.
Click for a quick & easy proposal.
Tips on Shopping for Individual Health Coverage
- Use the “Shop and Compare” tool at Covered CA to determine if you qualify for premium subsidy and if so, how much based on your household size, age, and income. If your income is below certain limits, you will qualify for Medi-Cal and your application will be routed to Medi-Cal by Covered CA, in which case premium subsidy for a plan other than Medi-Cal will not be available. Also, note that if you have group coverage through work and the cost to you is less than 9.5% of your income for self-only coverage (not including your family members), you and your family won’t qualify for a subsidy through Covered CA, regardless of your income (you can still buy individual coverage without a subsidy at open enrollment or if you have a qualifying event – see information below).
- If you don’t qualify for a premium subsidy or Medi-Cal, decide whether you want to apply through Covered CA or directly with the insurer outside of Covered CA, since generally the same or very similar plans a carrier offers in Covered CA will be available direct with that carrier outside of Covered CA. Customer service and policy issuance is often quicker and more efficient by applying directly to the insurance company.
- If you’re applying with Covered CA, be sure to select David Critzer as your agent once you’re in the online application by using the ”Get Help” link (top right hand application screen) then “Find Local Help” on the dropdown menu, and searching agents in zip code 95014. You may qualify for an “Enhanced” Silver plan if your household income falls in a certain range. If you do qualify for an Enhanced Silver Plan, this is often the best value choice due to the lower copays and deductibles on those plans. The other metal tier plans (Bronze, Gold, Platinum) don’t offer Enhanced plan designs.
- If you’re applying with Covered CA and you don’t qualify for an Enhanced Silver plan, then look at the regular Silver plans and the Bronze plans. A Bronze 60 PPO has a high deductible and a copay for the first 3 in-network doctor office visits in a calendar year, will cost you less per month than a plan with richer benefits, and is a popular option.
- Check the medical provider network for the plan and insurance company you are applying to (whether through Covered CA or direct with the carrier) carefully to make sure the doctors and other medical providers you want are in the network. You can do this directly from our website by quoting the plan. The PPO networks for most insurers offering individual coverage include less doctors and hospitals than the employer group plans from those same insurers. So don’t assume that because you had group coverage at your job with a certain insurer, the same doctor that was in the network on that group plan will be in the network on an individual plan. You have to specifically check each medical provider you need to be sure they are in the plan’s network.
- Because you can now buy individual coverage only at the annual open enrollment or when you involuntarily lose group health coverage or experience certain other “qualifying events”, you need to be more careful than ever not to allow your coverage to end before you have new replacement coverage, since you might be forced to wait until the next annual open enrollment before you can buy coverage. If you find yourself with a gap and buy “short-term” coverage to cover you to the next open enrollment, beware that most short-term plans require you to be in good health to obtain a policy and don’t cover health conditions that have been diagnosed or that you’ve been treated for prior to the date the short-term plan begins. Short-term plans also may not exempt you from tax penalties for being without coverage, since they don’t cover all the medical services regular individual plans are required to cover.
- And last, don’t wait until the last minute to apply for coverage. Because most applications are now submitted only at the annual open enrollment, Covered CA and the insurance companies are overwhelmed at open enrollment, as are insurance agents. So it’s important to leave enough time when applying for coverage to help offset the slower processing and customer service at open enrollment.