Health Care Reform Enrollment In California

Name: SPF Insurance Services
Address: 17927 Sencillo Ct, San Diego, CA, 92128, USA
Telephone: 858-613-3628
Price range: $0-$2000

Website Contents

Obamacare Information
Subsidies
Health Care Reform Subsidy Calculators
Health Plan Descriptions
Penalties
California Open Enrollment
Can You Get Insurance Outside Open Enrollment?
Health Care Reform News
Doctor/Provider Directories
Drug Formulary Search

Top Maternity Insurance Plans
Health Insurance If You’re Already Pregnant

Health Insurance for a Baby
Baby Health Insurance Prices
Best Child Health Insurance Plans In California
Health Insurance For Baby’s First Year: Group vs. Individual
Affordable Child Health Insurance in California

Best Health Plan Recommendations

Medical Insurance Plans in San Diego
Find New Medical Insurance In California

Top California HSA Plans
What Are Qualified Expenses For HSA Plans?
What Is A Health Savings Account?
List of California HSA Administrators

Health Sharing Medical Plans in California

Health Insurance San Diego Quotes

The 2025 California Open Enrollment Has Begun

Rates will be in the Quote Center 11/1–>>

The California open enrollment period will last until January 31st. All applications submitted between 11/1/24 and 12/31/24 will result in a new plan that starts on January 1st, 2025.

It is possible to get a plan that will start before 1/1/24 if you have experienced a qualifying event. Learn what these qualifying events are here.

The only people that should be using Covered CA are those that have an income low enough to qualify for premium assistance. To see if you qualify for premium assistance, see our California Subsidy Table. Everyone else should stay away from Covered CA.

Check out our analysis of the Best Health Insurance Plans in San Diego County. We have updated it to show the top health insurance plans for 2024.

If you live anywhere else, here’s the analysis of plans for the rest of CA, “What Is The Most Affordable Health Insurance In California?”

The Medicare Annual Election Period Is Open Until December 7th, 2024

During this time you can enroll in Medicare Advantage plans and Part D Drug plans. The Inflation Reduction Act has capped the out of pocket cost for prescription medications at $2,000 so most of the drug plans have had significant changes.

If you are newly eligible for Medicare (turning 65 or leaving a group health plan) we can help you understand your options and get you enrolled in a Medicare health plan.

Just a reminder, the Scripps Medical System will no longer accept Medicare Advantage plans. See our blog post to learn about what has happened, what your options are, and the pros’s and con’s of those options.

https://spfinsurance.com/2023/10/scripps-medical-system-not-accepting-medicare-advantage-plans-in-2024/

Call us to to get help with your options.
If you are enrolled in a Medicare Advantage plan or a Part D drug plan, you can shop for a better option now. The Annual Election Period ends on December 7th, 2024.

Call us and we can help you find the right plan for your needs.

California Health Insurance Companies We Work With

We offer medical insurance and Medicare plans from all the major companies:

Aetna
Anthem Blue Cross
Blue Shield of California
California Choice
Cigna
Health Net
Humana
Kaiser Permanente

Molina Healthcare
Oscar Health Insurance
SCAN
Sharp Health Plans
SilverScript
Sutter Health
United Healthcare
WellCare

Short Term Health Insurance Companies we work with:
None. California outlawed all short term plans effective 1/1/19.

Ask us about Life Insurance or Dental Insurance as well.

Karen Reeves

Tim is outstanding! He has the answer to any and all questions. He knows things about insurance that you couldn't possibly find out on your own. There are so many loopholes and details that we were not aware of that had a big impact on our decision. Tim made everything make sense. He spent a very long time on the phone with me, tirelessly answering my questions without any hesitation or shortness. Then he proceeded to call covered california on our behalf... If you have ever called there, you know the wait time is HOURS. It was a pleasure working with Tim and I would highly recommend him for ANY of your insurance needs. I would give him ten stars if it were an option and I am a picky customer.

Mom had health insurance with maternity coverage and baby is protected

California Maternity Insurance After Obamacare

Every plan in California now provides maternity coverage. But some plans are better at reducing your costs. We’ll show you which ones. Picking the right plan is now very important.

We’ll briefly cover the key benefits you’ll want in good maternity insurance, then we’ll show you the Best California Maternity Insurance Plans where you live, and we’ll review how Obamacare has effected maternity care options in California. Finally, we’ll give you a simple step by step process to find the right health coverage for your pregnancy and delivery, and show you a simple trick to reduce the overall cost of your baby.

Califosrnia health care reform is through Covered California

California Health Care Reform

Health Care Reform (aka Obamacare) rolled out on January 1st, 2014. This change in the health insurance market effects everyone. Learn what changes have been made, how it effects you, and find out how Obamacare works. We cover subsidies, the penalty for not having health insurance, and outline the benefits of all the new metal health plans.

As the starting point for all Health Care Reform information and strategies on SPF Insurance, you’ll find information about each open enrollment period, and all the qualifying life events that allow you to enroll in coverage outside of the annual enrollment periods.

What's The Right San Diego Medical Insurance For You

How To Find Good San Diego Medical Insurance

There are a lot of California health insurance plans to choose from. How do you find a plan that is affordable and provides the benefits you need?

Follow our 5 step process and you will quickly find the right plan. Not sure how to compare plans? We’ll show you the key benefits to compare, and what you can ignore.

The last step is the online application. If you’re comfortable doing it yourself we will tell you how. If you’d like help with the application, we’re just a phone call away.

SPF Insurance medical insurance recommendations

Health Insurance Information and Recommendations

In order to pick the right plan for your family or yourself, you need to know what is important. Trying to compare all the benefits of multiple health insurance plans will not work. We show you which benefits you are likely to use the most.
Once you know how to compare the key benefits of health plans, where do you start. We’ve created 6 typical situations that people call us about. Then we show you what plans are a good fit for those situations. You can use this to shorten your search time.

Diagram showing HSA Insurance Plan & Savings Account

Best HSA Health Insurance Plans In California | HSA Insurance Plans California

The only Health Savings Account compatible health plans left in California are all part of Obamacare. This means that most of the HSA plans are standardized plans that Covered California defined. As a result, we end up having to compare and choose between many plans that are identical.

The choice as to which of the options is the best plan for you depends on your circumstances. We’ll help you determine if an HSA plan is right for you, and show you why the top three HSA health insurance plans in California are:

Best Health Insurance Policy For Baby In California

On this page we will show how you can go about getting the right health insurance when your baby is born, and throughout the child’s life. This information will apply to you if you already have at least one young child, or are planning to begin your family. You will find that this process is easier to go through than you might think.

However, there are some pitfalls to be wary of. The article highlights several other baby health insurance pages that you should also read.

Click on the topic header to see the content inside

What Is The Best Health Insurance In California?

Determining which health insurance plan is the best in California depends on where you live. The best plans in San Diego are not the best plans in Los Angeles or San Francisco or Crescent City.

In southern California, the best health insurance plans are the following:

Health Net Silver 70 HMO
Oscar Health Silver 70 EPO
Kaiser Permanente Silver 70 HMO

If having the biggest network of doctors is more important, then the Blue Shield PPO plans will be your best option.

In northern California, the top plans are based on what’s available. I say this because there are typically fewer plans offered in many of the northern counties.

The best health plans in northern CA are the following:

Valley Health Plan Silver 70 HMO
Sutter Health Silver 70 HMO
Blue Shield PPO Silver 70 PPO
Kaiser Permanente Silver 70 HMO

I know that the medical plans I’ve listed above will not always be the best in every situation. But for the general scenario, most people will find these to be good.

Silver 70 Health Insurance Plans Are The Best Option For Most People

When you look at all the plans in any region, and you compare the price and benefits of the health plans, you’ll see that the Silver 70 plans tend to be the best “Value” amongst the various options. That’s why all the best plans are Silver benefits.

PPO Plans Cost More Than HMO Plans

This fact is true regardless of where you live in California. PPO plans are almost always the most expensive version of any Bronze, Silver, Gold, or Platinum plans.

There are a couple of reasons why this occurs. The first is that insurance companies can more accurately predict medical costs and the risks associated with members in HMO plans. As a result, HMO plans can typically show higher risk scores and therefore gain an advantage over their PPO competitors that are forced to show lower risk scores

The result is that HMO plans tend to receive “Risk Adjustment” payments from PPO health plans. This helps keep HMO plan costs lower and results in lower premiums.

The second reason is that HMO plans have more ability to control the claims costs by using Primary Care Physicians (PCP) to guide members to the right medical services. PPO plans let consumers decide if they want to see a specialist, while HMO plans require PCP to provide referrals to see a specialist only if it is needed.

See Our Analysis Of Baby Health Insurance and HSA Insurance Plans!

We’ve been busy putting together in-depth reports on Health Savings Account (HSA) health compatible coverage, and Baby health insurance in California. Each of the topics is covered with detailed recommendations and strategies to help you quickly get the information you need to make good decisions.

For California Health Savings Account health insurance we start with an overview of what HSA compatible health policies are, how they work, who they’re a good fit for, and which health plans we recommend. Then we cover what the Health Savings Account is, how it works, and where you can set one up, along with additional information on what qualified medical expenses are.

One of our popular topics is on Baby Health Insurance in California. Here we start with the birth of the baby and help parents decide which policy to put their new baby on. Then we cover what baby and child health costs look like, what well baby care is, and make specific recommendations for different types of children.

Go ahead and check these out, and be sure to LET US KNOW WHAT YOU THINK!

Get Quality Medical Services In San Diego

The Southern California and San Diego Health Insurance marketplace is served by all the major health carriers. The San Diego area is home to numerous research hospitals that provide state of the art health treatment technologies and modalities. The region also contains a variety of large medical groups, Scripps, Sharp, UCSD, and Arch Health, that contain specialists in every field of medicine. By selecting your physician from a large medical group you can be assured of getting comprehensive attention for all your needs.

With a strong biotech industry, 3 large university systems (San Diego State University, University of California San Diego, University of San Diego), and 29 hospitals, the residents of San Diego have a wealth of medical options when it comes to using their health coverage. San Diego is truly “America’s Finest City” both in lifestyle and health infrastructure.

Find California Individual Health Insurance That Fits Your Needs

The California lifestyle keeps people active and healthy. Surfing at the beaches, hiking the mountains, biking on scenic trails scattered throughout the state, and eating locally grown health food gives people in southern California a unique advantage over those that live almost anywhere else. The result of this is that individual health insurance San Diego rates tend to be lower than most of the rest of California, and much lower than anywhere else in the US.

The best way to get an individual health insurance plan is to follow the 5 step process outlined below. That way you get the full benefit of the knowledge and recommendations on this website. If you have any questions, please call us at 858-613-3628, and one of our advisors will be glad to help you.

San Diego Family Health Insurance, California

San Diego is a great location to raise a family. The school system is above average (some districts are top ranked within the state), the economy is diverse and offers jobs of all types, in many industries, and with a wide range of skill and education levels, and the region is a hotbed of small entrepreneurial start-ups and family businesses.

Because of these small family businesses, the need to provide affordable family health insurance is vital. At SPF Insurance we pride ourselves on being able to help families find medical coverage that fits their specific needs.

Whether it be a new couple just beginning a family and looking for maternity health insurance, or a family with 2 children in high school that needs good benefits but keep the premium costs down, we can help you get the family health insurance you need and can afford.

Spoiler title

5 Steps to Get The California Health Insurance Plan For You!

Go to the Health Insurance Quote Information page, and read the entry “4 Keys to Understanding Health Insurance Plans," and answer the 2 Pivotal Questions.
Look at the Recommendation Table on the Health Insurance Quote Information page to determine which category describes your situation, and then review the specific plans that best fit your category.
Run a Health Insurance Quote and click the "Check to Compare" boxes (in orange) beside the ones that were identified in the Recommendation Table and then click the "Compare" button to get a side by side view of the medical benefits.
See plans from all major California health insurance companies. Get the best deal!
Narrow your choices to 2-3 plans.
If you want to maintain your current doctors, then search the 2-3 insurance companies' provider directories for your doctor names. Choose the health plan that has your doctors and best fits your needs and budget.
If you earn too much to be subsidy qualified, then click on the “Apply Now” button in the quote next to the plan you selected. If you are subsidy qualified, then call us at 858-613-3628, or email to info at spfinsurance.com and we will help you complete the Covered CA application, or give you instructions on how to make the application easier.

If you have any problems or questions, please call us and one of our Advisors would love to help you.

Affordable Health Insurance in San Diego California

Shopping for affordable health insurance in California is fairly easy, as there is a wealth of resources you can find here on this website. What’s affordable to one person, may be considered expensive to another, so you first have to decide what affordable medical coverage means to you. The most common definition of affordable health insurance is it costs less than _________ (fill in your limit), the amount you can afford to pay.

Using this as the starting point, you can compare the low cost health quotes that are less than your upper limit. This can be done by running a health quote and then scanning down the list of options and checking the “compare” box next to the ones you are interested in.

There is always a trade-off between affordable health insurance in San Diego and cheap health insurance in San Diego. You’ll want to make sure that the benefits offered meet your needs. Be forewarned, cheaper is not always better. In maternity coverage, the low cost health insurance policies typically result in much higher total out-of-pocket expenses for the mother. However, high cost maternity insurance coverage isn’t the best option either.

At SPF Insurance, we’ve done the Price versus Benefits analysis to determine what health or maternity policy will provide the best cost and benefits

If you need some help or just want to bounce your ideas off a knowledgeable advisor, please give us a call.

How To Get Low Income Health Insurance in San Diego California

Low cost or free health insurance plans are available in every region of California for individuals and families with low income. The Affordable Care Act created “subsidies” which can reduce the cost of your health plan, and expanded the eligibility for Medi-Cal (California’s version of Medicaid).

To qualify for free low income health insurance San Diego residents need to have an income that is below 138% of the Federal Poverty Level. If so, then you can qualify for Medi-Cal.

If your income is above 138% but below 400% of the federal poverty level, then you may qualify for subsidized health insurance through Covered California. Covered California is the Obamacare Exchange here in the golden state. Get more details about this on Health Care Reform Subsidy page.

When Shopping For Health Insurance Self Employed People Need Know These 3 Things

Because you are self employed there are a few pitfalls you need to be careful about. First is that your health insurance choice will last for a full year. You will have limited ability to change your coverage outside of the special enrollment periods and open enrollment periods.

Second is that when you are initially starting out working for yourself, and shopping for health insurance, self employed individuals and their families may qualify for subsidized coverage now (Obamacare). If so, then you need to check the networks your doctor accepts, determine what type of coverage you and your family needs, and then get health insurance quotes “On Exchange” through this website./p>

The last item is that as your self employment income increases, your subsidy amount will decrease. We’ll need to review your income situation a couple times during the year to determine if we need to report a change to your Covered Californa application. This will help to keep you from having to repay extra subsidies to the IRS when you file your tax return next year.

Look in the Health Care Reform section of the website for more details about this, or give us a call and we’ll help you directly.

If You Vacation In Exotic Locations You'll Need Travel Health Insurance

Everyone needs a good long vacation now and then. If that holiday is to a country with exotic flora and fauna, then you’ll want to be prepared.

Bugs, local water, and natural bacteria that only exist in those locations could land you in a hospital. That’s where inexpensive travel health insurance steps in and provides you with coverage. These plans provide coverage for all medical needs and offer an extensive network of doctors world wide.

For more details, click here.

Do You Need Health Insurance For Students?

Most major universities now require students to have health insurance coverage. You have the choice to use the student health insurance plan offered by the university, or you can get your own health plan.

You have to be a little bit careful if you choose to get your own health insurance for students. The reason is that the school probably has a minimum set of benefit requirements. Many times these minimum requirements are very hard to get in regular health insurance plans.

Schools want the student to be healthy and in class every day. Therefore, the health insurance plans are required to provide benefits that would encourage students to get help at the first sign of a cold.

If you are going to shop for your own health insurance, then find out what the school’s health plan requirements are and compare those to the plan benefits shown in regular health insurance quotes. If you need assistance, please call us and we’ll be happy to help.

A Word About Cheap Health Insurance

Caveat emptor, or “let the buyer beware” is a good starting point for discussing cheap health insurance in San Diego or anywhere in California. The health care reform changes have regulated what the health insurance plans are, and what the minimum benefits must be.

Health Insurance rates and prices are approved and regulated by the State of California Department of Insurance. Therefore, the prices of all plans really don’t qualify as being “cheap” anymore.

The cheap health insurance plans are only going to be available to you if you qualify for subsidized health insurance through the California health exchange. If your income is low enough, you may qualify for the cheapest health insurance of all: Medi-Cal, the California version of the federal Medicaid program.

“You get what you paid for” is the best way to describe Medi-Cal. Many people are complaining that they can’t find a physician that takes NEW patients. Therefore, your cheap Medi-Cal coverage may not provide you with much coverage.

If that is the case, then you can apply for a hardship exemption through the healthcare.gov website and when approved get a Catastrophic health plan for the lowest monthly premium.

Three Types Of Health Insurance Plans Are Available

There are three primary types of medical insurance plans available, Health Maintenance Organizations (HMO), and Preferred Provider Organizations (PPO), and Exclusive Provider Organizations.

HMO Health Insurance

HMOs were initially started in the ’70s as a way for the medical insurance industry and government to provide better medical services for individuals by having a Primary Care Physician (PCP) act as a central contact for all medical services delivered to a patient. Any special medical needs were coordinated through the PCP to ensure that the patient received the proper treatment.

This service delivery model still exists today. Each patient is required to select a PCP, and the PCP will refer the patient to a specialist if needed. HMOs work well if your doctor is part of a large Medical Group in San Diego County. A few of these large medical groups have over a thousand doctors within them, with at least one physician in each specialty.

For some people, HMO plans have a negative stigma. It’s believed they are set up to prevent patients from getting the treatment they need. The PCP is seen as a gatekeeper, driven to minimize the service costs for each patient. This is not the case, and HMOs using large medical groups can actually seem more like a PPO plan. In large groups, the group can “internally refer” you to see a specialist for routine and ongoing care.

PPO Health Insurance

Preferred Provider Organizations allow the patient to visit any physician in the plan’s network of providers. If the patient decides to see an Orthopedic Surgeon because of an injury, they simply choose an Orthopedic Surgeon from the health company’s network of doctors. This freedom of choice makes PPOs very popular in the California Medical Insurance marketplace.

PPO plans also allow patients to see physicians outside the network if needed. Visits to doctors out of the network may require larger out of pocket costs for the patient but will provide the ability to get treatment from ANY doctor.

The major health insurance companies in Southern California have large networks of PPO physicians. However, Obamacare reduced the size of all networks, so it is still a good idea to make sure that your physician is in the network before you apply for a policy.

EPO Health Insurance

Exclusive Provider Organizations are just like PPO plans, but with one difference. In an EPO plan patients are not allowed to see a physician that is not in the insurance companies’ network. If a non-network provider is used, then patients will pay the full cost for all medical services received.

In an EPO plan individuals will be able to get emergency treatment without having to see a network provider. Once the emergency is over, all follow up treatment will need to be from a doctor in the network.

HSP Networks

Health Net created the Healthcare Service Plan (HSP) network as a way to bypass the CA Department of Insurance.

The HSP works just like a PPO plan, in that you can see any doctor you want as long as the doctor is in the HSP network. What makes it slightly different from a PPO is that you must pick a Primary Care Physician.

You do not have to go see your PCP before going to a specialist in the HSP network. The HSP is an odd PPO network with the requirement that you select a PCP.

Best San Diego Health Insurance Broker Serving California