INDIVIDUAL/FAMILY HEALTH INSURANCE Oceanside & Carlsbad CA

“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States.

With the individual health insurance market experiencing historical changes as a result of the PPACA (Patient Protection and Affordable Care Act) initiated in 2010, Serra Benefits has held steadfast through these changing times. We are certified with Covered California, our states healthcare exchange, which makes us even better able to evaluate your circumstances and help you make an educated and informed decision on the best policy. We can answer all your healthcare questions and keep you up to date when the market changes again.

Enroll via phone appointment

In-person assistance by request

760-439-9700

Types of Health Insurance

• HMO – Health maintenance organization – Typically smaller network/Managed Care

• PPO – Preferred provider organization – Larger network/Most freedom

• EPO – Exclusive provider organization – Cross breed of HMO and PPO 

• HDHP – High-deductible health plan – Health plan compatible to use with an HSA account (health savings account)

HMO VS PPO

One big difference between HMO and PPO policies for many is the requirement to have a primary care doctor who manages general care and handles specialist referrals when deemed necessary. Often, HMO plans have lower premiums due to this managed care system and lower contracted rates with the doctors.  If flexibility to get services without referral and see doctors anywhere in network is desirable, then a PPO may be the best option. Some find more comfort in managed care through an HMO with predictable out of pocket costs and often lower overall premiums, while others need more freedom to choose from a larger doctor network and the ability to go out-of-network if needed. Serra Benefits will make this easy and help find the best fit for you at no cost.

Covered California (On-Exchange) VS Private/Direct (Off-Exchange) – Which One?

Great question! It really comes down to whether the taxable household income qualifies you for tax credits or not. Eligibility is based on household adjusted gross income, number of people in the taxable household, age of those in taxable household, and zip code. We can quickly determine your eligibility to decide which path is best for you. 

Open Enrollment Period (OEP)

The annual time frame when anyone may apply for health insurance, change health insurance companies, and/or change the level of coverage on or off exchange without a qualifying life event.

Enroll 11/1-12/15 for January 1st Effective Date

Special Enrollment Period (SEP) 

Consumers who experience a qualifying life event may enroll on or off exchange within 60 days of the life event. This is a called special enrollment period. PROOF is REQUIRED. Refer to the Covered CA website for more information.

Common Examples:

• Losing health coverage. For example: consumers who no longer qualify for Medi-Cal, or who lose health coverage through their job or spouse’s job.

• Turning 26 years old and no longer being eligible to stay on a parent’s plan.

• Moving from another state or moving within CA to an area that doesn’t have current plan service 

• Having a child, adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.

• Getting married or legally entering a domestic partnership.

Due Dates to Enroll after a Qualifying Life Event

Consumers have 60 days to enroll on or off exchange from the date of their qualifying life event.  If 60 days pass and consumers have not signed up for health coverage, they will have to wait until the next open-enrollment period and will be subjected to the individual mandate penalty.

Healthcare News

• California legislation passed AB 414. It requires ALL California residents to purchase health insurance for themselves and their dependents to maintain minimum essential coverage (MEC). California is one of several states that are actively pursuing, or have already adopted, their own statewide individual mandates.
• The individual mandate for Californians started 2020. The penalty for not having insurance will mirror the one under the Affordable Care Act. That can amount to thousands of dollars a year in penalties.
• Advance Premium Tax Credit (APTC) received through Covered CA is reconciled at the end of the year when your taxes are filed. If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you may have to pay back the excess when you file your federal tax return. If you’ve taken less than you qualify for, you may get the difference back.
• How does the tax credit (subsidy) work? The IRS pays your premium tax credit directly to your health insurance plan. Your monthly premium costs are lower as a result. … The only way to get premium tax credits is to buy through Covered California. If you bought through Covered California, you are sent a tax form, called the Form 1095-A at the end of each year to submit when you file your federal income tax return on or before the due date.
• The Patient Protection and Affordable Care Act (PPACA) has mandated all plans to be guaranteed issue. No one may be denied. No one may be rated up due to pre-existing conditions or medications.