Covered California
Certified Agent

Health Insurance – A Detailed Guide

Health insurance can be tricky to navigate because the coverage, price, and availability vary from state to state. Different types of private and government-run health insurance plans are available to protect people from the large chunk of treatment bills following a health scare.

People aged 65 and over or those that qualify for disability can benefit from Medicare and Medicaid. However, these plans target low-income groups, and quality healthcare should be accessible and affordable for everyone.

People can choose private insurance from their employers or invest in an individual healthcare insurance plan for themselves and their loved ones. However, it’s important to consider all potential options when choosing the right health insurance plan that meets your budget and specific needs.

At Covered California Certified Agent, we understand that this is easier said than done because numerous confusing factors remain. That’s where our insurance company comes in.

We’re a one-stop solution for individuals and employers looking to protect the valuable people in their lives. Several types of insurance plans are available to get coverage for health and other concerns like routine dental and vision.

Here’s an overview of the different coverage options at your disposal when you consult our insurance agents to draft a health insurance policy that effectively meets your needs. But first, why get health insurance in the first place?

The Importance of Health Insurance

woman visiting a doctor

Undoubtedly, the US has one of the best public healthcare systems in the world, where Americans can enjoy quality medical treatments irrespective of age, savings, and income levels.

However, healthcare is expensive in the US, and without insurance, it could be an enormous financial burden. So people often wait far too long to get treated, and the conditions worsen over time or make individuals go bankrupt because of exorbitant medical bills.

The system is under continuous pressure to cope with a population that’s aging. Moreover, life expectancy is increasing much faster than health expectancy, increasing population and demand.

Population Data shows that the demand for healthcare is likely to rise faster than the nation’s ability to fund it through taxes. In addition, not all costs or treatments are covered by the public health system.

When it comes to future planning, medical insurance provides protection not only when you’re sick but also keeps you from falling sick. It’s a safety net that can be a lifesaver if you unexpectedly fall sick, get injured in an accident, or need emergency treatment.

A comprehensive health insurance plan gives people the peace of mind that they won’t need to handle medical bills while they recuperate from the injuries.

No one knows what health problems may impact them or their family and earning abilities in the future. Still, a health insurance plan will enable you to get treated promptly. You can also rest assured that all or most costs can be recovered.

Different Types Of Health Insurance

specialist helping clients at the top insurance agency in CA


The federal health insurance program insures disabled people and seniors over 65. Part A of the Original Medicare covers healthcare services, such as hospital inpatient treatment, certain specialized nursing facilities, hospice care, and some home healthcare. Part B covers everything from outpatient care to in-home care and durable medical equipment. It also includes certain preventive care, such as screenings and vaccines to prevent illnesses.

Beneficiaries can get coverage through the government or private insurance providers with Medicare part C, also known as a Medicare Advantage plan. Sticking with the Original Medicare means they can expand coverage with a Medicare Supplement (Medigap policy) and Prescription Drug coverage.

Family and Individual Plans

This refers to the plans that people can enroll themselves in, under the Obamacare or Affordable Care Act. These are available to everyone and can be bought through health insurance companies, federal or state marketplace, and insurance brokers.

However, they need to be more vigilant about the agency they choose to work with. Researching independently and making decisions without much-needed experience can lead to undesirable circumstances or budget blowouts. Schedule a consultation with specialists at Covered California Certified Agent to get a health insurance plan based on your needs.


Sometimes people enroll in temporary or short-term health insurance plans to bridge any gaps in their coverage. In most states, the short period can be anywhere from a few months to three years.

dentist showing an Xray to a female patient

Dental and Vision

Health insurance doesn’t cover routine dental care. Since dental treatments can be incredibly expensive to pay out of your pocket, getting dental insurance as a preventive measure is a great idea.

Dental care covers a significant percentage of costs for basic, restorative, and preventative dental services, depending on your plan.

Similarly, routine vision care is also not included in most health insurance plans. To get coverage for eye exams, contacts, and glasses, you’ll need separate insurance coverage.


Widely known as a small group or group health coverage, this type of insurance is provided by employers as an additional benefit to motivate employees. Employees can choose to split the cost of the monthly premiums with their employers.

Group health insurance helps attract and retain the best talent as employees feel safe working at your company. They get the perception that the company cares about their well-being, which leads to increased morale and productivity.

Moreover, employers won’t have to pay taxes on the insurance premiums if they offer group health insurance to their staff, as they can be written off as business expenses. Employers can choose many other plans based on the coverage requirements, how much they’re willing to spend, and some other factors. Let’s briefly learn about each type of plan.

Preferred Provider Organization (PPO)

The PPO plan is offered by employers that encourage employees to use a specified network of hospitals and doctors to receive their medical needs at a discounted or negotiated rate. Nearly 48% of people choose PPO as an employer-sponsored plan.

Employees can choose any healthcare practitioner within the network. They must meet an annual deductible before the health insurance company covers the medical bills.

Some services come with co-insurance or co-payment features where they have to pay a certain percentage of the total charges. And higher out-of-pocket costs will be incurred for services outside the network. The monthly premiums are relatively higher for PPOs, but the employees will have the freedom to choose and healthcare facility without needing a referral from a primary care physician.

Health maintenance organization (HMO)

These plans offer a broad range of healthcare services through the network of facilities that are contracted to provide services exclusively to the members. Employees must choose a primary care physician and obtain a referral if they need to consult a specialist.

However, HMOs typically offer extensive coverage for preventive care and have a low premium or no deductible. The plan helps lower out-of-pocket costs for prescriptions, but they don’t cover non-emergency patients that go outside the network without proper authorization.

small business owners searching for affordable insurance services in CA

Health Savings Account (HSA)

The HAS-qualified plan is a tax advantage account used with the HAS-compatible high deductible plans to pay for medical expenses that qualify. These can be attached to the group health insurance policies or standalone policies.

The account goes with employees when they leave and can only be useful if you’ve got an HDHP. These HSA contributions can be pre-tax and up to the limits that the IRS sets annually. All unused funds in the HAS roll over every year and accrue tax-free interest. The workers can withdraw funds even for non-medical expenses, but it will incur interest and penalties if the age is below 65.


Fee-for-service or indemnity plans refer to the predetermined percentage that the insurance company pays for customary and reasonable charges for a service. It’s usually the average fee for the service within the geographic area.

The remaining amount is paid by the insured. There’s no provider network restriction with indemnity plans, so patients can choose their hospitals and doctors. The providers will define the fee for each service covered as it may vary from one physician to the next.

Therefore, it leaves the insured on edge for potentially unexpected and hefty medical bills that depend on the amount the provider charges for the service. While the plan is flexible and doesn’t require committing to one specific primary care physician, it’s expensive, with costs ranging from factors like age, geographic location, and the benefits you want to include.

Alternative Health Insurance Options

insurance agent helping clients with medical insurance

If you’re an employer looking for something other than traditional health insurance plans, alternative options for providing healthcare benefits include health stipends and HRAs.


These are IRS-approved health benefits funded by employers. They allow reimbursing the employees for all qualifying medical expenses tax-free, including out-of-pocket costs and individual health insurance premiums. These plans allow for complete budget control by setting an allowance amount for all employees.

Workers also enjoy the freedom of choosing the type of care and healthcare facility that works best for them. They can purchase coverage from their chosen insurance carrier that suits their needs and location rather than being forced into a one-size-fits-all plan.

Full-time Equivalent Employees (FTEs), Qualified Small Employer HRA (QSEHRA), Group Coverage HRA (GCHRA), and Individual Coverage HRA (ICHRA) and the few popular types to know about.

Health Stipend

Another flexible choice for employers who currently don’t offer any healthcare benefits. These stipends help employers offer medical expense reimbursements or taxable monthly allowances, even costs normally not covered under HRAs or other types of insurance.

Health stipends can also be offered to more employees, such as international employees or contractors, which isn’t the case with HRAs. They’re excellent for employers who benefit from advanced premium tax credits as they can continue enjoying the APTC advantages and the stipend.

But stipends are taxable for both the employee and the employer, unlike HRAs. So the amount will need to be reported as taxable income. The option is suitable if your organization cannot yet support a group health plan or want more control over the expenses that qualify for reimbursement.

Buying Health Insurance

Depending on many factors and the type of health insurance you’re looking for, you may be able to purchase the policy at any time of the year or may have to wait until the annual open enrollment period.

Affordable Care Act plans have enrollment periods that vary by state. But if you experience a qualifying life event, such as divorce, loss of employer-sponsored health insurance, relocation to a new area, or other circumstances, you might be eligible for the special enrollment period.

illustration about health insurance

However, many other types of insurance policies can be purchased year-round. If you have queries, California’s top insurance agents are at your service to navigate the perils of insurance services.

As a leading insurance agency in California, Covered California Certified Agent can help you figure out the right insurance plans for you, your employees, and your loved ones. We’ve helped businesses in various industries pick the right employer group insurance plans within their budget to provide their employees with adequate coverage.

These include employee health insurance, corporate insurance, term life insurance, medical insurance, dental insurance, and many other health insurance services.

The seasoned insurance agents at our insurance company always strive to provide fantastic value for money for our clients and place love and care at the heart of everything they do.

They’ll guide you every step of the way about various health plan names and policy types as you evaluate the best options, leaving you better equipped with the knowledge needed to pick the ones that fit your budget and needs. You can also connect with us for individual health insurance.

Give us a call to talk to specialist insurance agents at a top health insurance agency in California to get started on debt-free and stress-free living.