Although I am not an insurance broker, I have dealt with insurance companies and government social welfare agencies several times, and have a little understanding of medical insurance. This article will introduce the popular science of American health insurance (medical insurance) and share the basic concepts. In addition to the federal regulations that are common to the whole country, the regulations of each state government and the insurance system may be different. I will focus on "California" in this article. If there is anything unclear or wrong, please leave a message below and let me know.

2022 health insurance (medicare) key scan

• California has mandatory health insurance requirements: Obamacare originally punished people who did not have health insurance, but in 2019, the Trump administration abolished the fine system and no longer forced to buy health insurance, but state governments can still maintain their own policy implementation direction. Since 2020, California has passed a bill to reinstate compulsory insurance, in other words, everyone in California must have health insurance or face fines on state tax filings. The penalty amount is $750/year for each adult and $375/year for children aged 18 and under, when the tax is filed in 2022, the official will use the 2021 household income data as the standard and impose a fine (source).

• California's Enrollment Insurgencies are slightly longer: Covered California's Open Enrollment enrollment period begins on 2021/11/1(a) this year and will not take effect on 2022/1/1/15(iii) until 2021/1/1.00). If it is too late to register during this time, the State of California may extend the registration until 2022/1/31 (A), but the effective time will be postponed. If you miss out again, you can only register for medical insurance if you meet the special special enrollment period (SEP).
  

If you are already enrolled in the Covered California Health Insurance Plan, but want renew, you can already renew in the system from 2021/10/1.

• The number of health insurance companies participating in Covered California increased: Alameda, Contra Costa, El Dorado, Marin, Napa, Placer, Sacramento, San Francisco, San Mateo, Solano, Sonoma and Yolo will have Anthem Blue Cross options; Monterey and Santa Barbara will have blue shield of California's Trio HMO program as an option; In 2022, california residents will have at least 2 insurance companies to choose from, and 94% of residents will even have more than 3 companies to choose from.

• Covered California premium growth is under control: The average premium increase for California health insurance in 2021 was 1.8%, which controlled the average increase in the three years of 2020-2022 at only 1.1%.

• tightening of the medicare premium subsidy threshold: in 2022, the california government raised the medicare premium subsidy threshold, and the subsidy threshold was tightened from 6 times the federal poverty line to 4 times the federal poverty line, and many middle-income families who enjoyed premium subsidies last year may not qualify this year. single aristocrats earn $51,520 a year, a family of two earns $69,680 a year, and a family of four earns less than $106,000 to receive medicare premium benefits.

• Covered California announced an overall 1% drop in dental insurance plan premiums for 2022.

2022 u.s. medicare open enrollment reminder

The 2022 U.S. medical insurance will not be effective until it is registered during the Open Enrollment period of 2021/11/1 (Mon) - 2021/12/15 (W).

attention california residents

Covered California's Medicare Open Enrollment enrollment period starts this year from 2021/11/1 (A) and will not be effective until 2021/12/15(Wed), and the insurance will take effect on 1/1/2022. If it is too late to register, the State of California can extend the registration until 2022/1/31 (I), but the effective time will be postponed, and not all insurance companies and plans may cooperate with the extension of the opening, it is recommended to complete it within the specified registration time.

what if i miss my u.s. medicare enrollment time?

Eligible for a Special Enrollment Period (SEP), such as sudden loss of health insurance (e.g. unemployment), moving, marriage, widowhood, childbirth or adoption and other major life transitions requiring medical insurance, are not limited to the Open Enrollment period and can purchase medical insurance for 60 days after the event.

If you are not sep eligible, you will not be able to register if you miss the Open Enrollment registration time and must wait until the next year when Open Enrollment opens to purchase health insurance.

how to buy u.s. personal health insurance

Can I not buy insurance (Why)

In the past, ObamaCare (officially known as Affordable Care Act, ACA) stipulated that everyone had to have health insurance, and if not, they would not only have to pay huge medical expenses, but also be fined by the government. While the Trump administration rolled back mandatory fines in 2019, states have the power to customize them.

while the federal government doesn't fine, the california government does!

starting in fiscal 2019, the federal government will no longer force everyone to have health insurance, and there will be no fines without health insurance! however, state governments can still implement their own health insurance policies. california passed a bill that would reinstate mandatory health care requirements for everyone from january 1, 2020, or face fines, which will continue in 2022. california's latest rules are:the amount of the fine is $750/year per adult and $375/year for children 18 years and younger, and will be investigated and processed annually when filing taxes.

Who Needs To Buy U.S. Health Insurance (Who)

if you do not have medical insurance provided by your employer, spouse's employer, school, government, or if you are no longer eligible for your parents' insurance program over the age of 26, you must purchase your own health insurance.

1. international students: the school will force students to buy insurance and provide proof of insurance before completing registration. generally speaking, the insurance company that directly cooperates with the school purchases student medical insurance, and the procedure is the simplest and easiest.
   

2. Low-income households: Depending on the individual household income, each state with an annual income below the poverty line can apply for a free Medicaid program (white card) hosted by each state, and the eligibility limit is different for each state. California's Medicaid is called Medi-Cal, and it's not eligible to click here. If you don't qualify for Medi-Cal, try buying from the Covered California platform, the marketplace for medical plans, and then apply for government grants.
   

3. Seniors over the age of 65: Seniors over the age of 65 with citizenship/green card status can apply for Medicare (Red and Blue Card) here. If the income is low, you can also apply for a white card, so that the white card can bear the part of the red and blue card that needs to be paid out of pocket.
   

4. For more details on white and red-blue health insurance benefits, see this guide to "Comparative Analysis of Eligibility Criteria and Medical Benefits for Medicaid & Medicare Applications in the United States."
   

Have a job: If the employer provides insurance, it registers directly with the company (Group Health Insurance), otherwise you have to buy Individual Health Insurance yourself, and where to buy it can be seen in the next paragraph.

Where to Buy U.S. Health Insurance (Where)

1. Health Insurance Marketplace, the government's health insurance marketplace platform: If you purchase and apply for subsidies through ObamaCare's healthcare marketplace platform, you must submit tax return data and proof of income to assess eligibility, Covered California is California's healthcare marketplace platform

   2.Find an insurance broker Insurance Agent: The advantage is that the insurance broker will evaluate the most suitable insurance plan and can assist in the process.

And there are many Chinese-language insurance brokers now, so don't worry too much about the English is not good enough to understand the insurance regulations.

   3. Find a health insurance company to buy insurance directly Health Insurance Company: Buy directly with a health insurance company without an insurance broker. Now the websites of major insurance companies are doing a good job, you can clearly compare and buy online, and there are also online customer service that can help in time.

the best insurance companies in the united states are as follows, but the benefits of each company are different in different states, so the best in los angeles is not necessarily the best in new york, you can inquire about it.

Blue Cross Blue Shield

Humana

Kaiser Permanente

Aetna

UnitedHealthcare

Cigna

High-end introduction: Covered California California Full Insurance

Covered California is California's health insurance marketplace, and government subsidies can be obtained if you purchase a health insurance plan from California All Insurance, the annual household income in 2021 is between 138% and 400% of the federal poverty line, and you can provide tax return data and proof of income. I suggest that regardless of your income, you can go to Covered California for a comparison.

Covered California adopts a grading system, divided into four welfare levels such as bronze, silver, gold and platinum, the higher the level, the more expensive the premium, but the lower the medical expenses that need to be borne by themselves, and they can choose according to their own medical needs.

Bronze: 60% insurance, 40% self-cover

Silver: 70% of the insurance burden, 30% of the self-payment; In some cases (where the income meets the criteria) individuals can also maintain the Enhanced Silver plan, divided into three levels of 94%, 87%, 73%, but only pay the Silver plan

Gold: 80% insurance, 20% self-cover

Platinum: 90% insurance, 10% self-covered

4. What medical insurance to buy (What)

suppose everyone has a doorway to health insurance, to explain the vocabulary that is always dizzying, to know how to buy the right insurance for yourself.

1. expense nouns

Premium: Premiums paid on a regular basis

Co-Pay: A bit like the registration fee, every time the Office Visit has to pay, the general clinic amount is about ten or twenty yuan, if it is a specialist clinic may be slightly more expensive, the specific fee how to plan differently.

Deductible: Like car insurance, you need to cover yourself within the amount of Deductible. For example, if your Deductible is $1500, the amount within $1500 must be paid by yourself, and the cost of more than $1500 will be borne by the insurance company and the insured in proportion. The higher the deductible, the cheaper the premium and vice versa.

Coinsurance: Usually a percentage, deductible will not be encountered until the amount is full. For example, if you choose 30% Coinsurance, the medical expenses are $100, the insured only needs to pay $30 out of pocket, and the insurance company will cover the remaining $70.

It should be noted that the Coinsurance received by on-network and off-network medical services is different, and the Coinsurance of out-of-network medical services will be higher as usual.

Out-of-pocket maximum/limit: All the money you pay for yourself adds up to more than this limit and is paid in full by the insurance company. For example, Out-of-pocket Max is 10,000 knives, and this year's Deductible and Coinsurance medical bills add up to 25,000 knives, you only need to pay 10,000 knives, and the remaining 15,000 are paid by insurance companies.

1. types of medical insurance plans
   

HMO (Health Maintenance Organization): One of the most common health insurance plans is to choose a Primary Care Physician (i.e., a family physician) who, if you want to see a specialist, must first go to the family physician for referral referral (emergency and obstetrics and gynecology can be directly visited, no need for referral), and these specialists must be online doctors. Premiums are usually cheaper.

PPO (Preferred Provider Organization): One of the most common health insurance plans, you don't need to choose a family doctor, you can go directly to a specialist. Physicians inside and outside the medical network can see it, but the amount that doctors outside the network may pay is higher. Higher premiums.

⚠️Since 2019, the benefits of the California PPO program have been greatly reduced! In the past, in other states, they could also enjoy the same welfare claims as in the state; But now only emergency care and emergency rooms are available in the outer states.

POS (Point-of-service): A health insurance plan between an HMO and a PPO that requires a family physician and a Referral for a specialist, but an off-line physician.

EPO (Exclusive Provider Organization): You can choose and only any doctor on the network, but no Referral is required.

FFS (Fee for Service): Pay per service. The advantage is that it is flexible and will not restrict the choice of hospitals or doctors, etc., but you must first pay the fee yourself, and then refund the refund proportionally with the insurance company Claim. This premium is relatively expensive.

HSA (Health Saving Account): The concept of a health savings account (with people and not with companies), a certain amount of money is called out of the income to be stored in this account as medical expenses, and this amount is not taxed. To open an HSA you must choose a high deductible insurance plan.

COBRA (Consolidated Omnibus Budget Reconciliation Act): The full name is complicated, but in short, if there is a sudden period of no insurance Cover due to sudden unemployment or job change, COBRA will continue to provide medical insurance, but the premium will be slightly higher.

When to Buy U.S. Health Insurance

If an individual wants to buy, renew, or change health insurance, it must be completed within a nearly two-month Open Enrollment period. The registration period for 2022 is from 2021/11/1 to 2021/12/15, and medical insurance can only take effect on 2022/1/1.

Open Enrollment registration in Covered California begins this year on 11/1/2021 and will not be effective until 1/1/15/2021. If it is too late to register, California can extend the registration until 2022/1/31, but the effective time will be postponed, and not all insurance companies and plans may cooperate with the extension of the opening, it is recommended that you complete it within the specified registration time.

However, if there is any major change, such as marriage, pregnancy and childbirth, or sudden lack of insurance (such as unemployment), it is not limited to this, and you can enroll at any time. You can use this website to find out if you can purchase health insurance at a time other than Open Enrollment.

How to Buy U.S. Health Insurance (How)

1. assess the individual's health status: whether there is a chronic disease, regular follow-up, return to the clinic to get medicines, etc

2. assess family status: parents, spouses, children, etc., and decide the content of the family plan according to the situation

3. budget: if there is no government subsidy, the insurance premium cannot run away on average more than two or three hundred yuan per month

4. compare insurance plan options: if you are too lazy to check it yourself, find an insurance broker to help assess needs and help with quote

5. correctly understand the insurance plan and decide which is best for you

6. medicare in the united states does not include dental insurance and vision insurance, and must be purchased separately if necessary.

There are official resources available online, such as Obamacare Facts or the California Department of Health Care Services.